Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w

Differences in Outcome of Patients with Cardiogenic Shock Complicated by In-Hospital or Out-of-Hospital Cardiac Arrest

J. Rusnak1, T. Schupp1, K. J. Weidner1, M. Ruka1, S. Egner-Walter1, J. Forner1, T. Bertsch2, M. Kittel3, K. A. Mashayekhi4, P. Tajti5, M. Ayoub6, M. Behnes1, I. Akin1

1I. Medizinische Klinik, Universitätsklinikum Mannheim, Mannheim; 2Institut für klinische Chemie und Laboratoriumsmedizin und Transfusionsmedizin, Klinikum Nürnberg Nord, Nürnberg; 3Institut für klinische Chemie, Universitätsmedizin Mannheim (UMM), Mannheim; 4Innere Medizin und Kardiologie, MediClin Herzzentrum Lahr/Baden, Lahr/Schwarzwald; 5Gottsegen György National Cardiovascular Center, Budapest, HU; 6Allgemeine und Interventionelle Kardiologie/Angiologie, Herz- und Diabeteszentrum NRW, Bad Oeynhausen;

Objective: The study investigates the prognostic differences in patients with cardiogenic shock (CS) complicated by in-hospital (IHCA) or out-of-hospital cardiac arrest (OHCA). Background: CS complicated by IHCA or OHCA is known to have poor outcome. However, studies regarding the prognostic differences of IHCA and OHCA in CS is limited.   Methods: Consecutive patients with CS from June 2019 to Mai 2021 were included monocentrically. Resuscitation status was documented on admission for each patient. The prognostic impact of IHCA and OHCA on the primary endpoint of all-cause mortality at 30 days was tested within the entire group and in the subgroup of patients with acute myocardial infarction (AMI) as well as in patients with prior coronary artery disease (CAD). Statistical analyses included univariable t-test, Spearman´s correlation, Kaplan-Meier analyses, as well as uni- and multivariable Cox proportional regression analyses.   Results: 151 patients with CS and cardiac arrest were included. IHCA on admission was associated with higher all-cause mortality on day 30 in Kaplan Meier analysis (72 % vs. 64 %; log rank p = 0.046). However, this association was solely driven by patients with AMI (77 % vs. 63 %; log rank p = 0.023), whereas IHCA was not associated with the primary endpoint of all-cause mortality in non-AMI patients (65 % vs. 66 %; log rank p = 0.780). This finding was confirmed in the multivariable COX regression, in which IHCA was associated with 30-day all-cause mortality in the entire cohort (HR = 1.794; 95% CI 1.053 – 3.056; p = 0.031)  and in CS-patients with AMI (HR = 2.477; 95% CI 1.258 – 4.879; p = 0.009), whereas no significant association could be seen in the non-AMI group as well as in the subgroup of patients with and without CAD.   Conclusion: Patients with IHCA showed a significant higher all-cause mortality at 30 days compared to patients with OHCA. This finding was primarily driven by a significant increase of all-cause mortality at 30 days in CS-patients with AMI and IHCA compared to CS-patients with AMI and OHCA.

https://dgk.org/kongress_programme/jt2023/aP2124.html