Prognostic impact of admission time in infarct-related cardiogenic shock: an ECLS-SHOCK substudy
Background - The outcomes of patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS) and the efficacy and safety of extracorporeal life support (ECLS) may be affected by the timing of hospital admission. - Objectives - The present ECLS-SHOCK substudy sought to investigate...
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| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
14 October 2024
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| In: |
JACC Cardiovascular interventions
Year: 2024, Volume: 17, Issue: 19, Pages: 2228-2239 |
| ISSN: | 1876-7605 |
| DOI: | 10.1016/j.jcin.2024.08.013 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1016/j.jcin.2024.08.013 Verlag, lizenzpflichtig, Volltext: https://www.sciencedirect.com/science/article/pii/S1936879824011002 
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| Author Notes: | Tobias Schupp, MD, Holger Thiele, MD, Tienush Rassaf, MD, Amir Abbas Mahabadi, MD, Ralf Lehmann, MD, Ingo Eitel, MD, Carsten Skurk, MD, Peter Clemmensen, MD, Marcus Hennersdorf, MD, Ingo Voigt, MD, Axel Linke, MD, Eike Tigges, MD, Peter Nordbeck, MD, Christian Jung, MD, Philipp Lauten, MD, Hans-Josef Feistritzer, MD, P HD, Janine Pöss, MD, Taoufik Ouarrak, MSC, Steffen Schneider, PH D, Michael Behnes, MD, Daniel Duerschmied, MD, Steffen Desch, MD, Anne Freund, MD, Uwe Zeymer, MD, Ibrahim Akin, MD |
| Summary: | Background - The outcomes of patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS) and the efficacy and safety of extracorporeal life support (ECLS) may be affected by the timing of hospital admission. - Objectives - The present ECLS-SHOCK substudy sought to investigate the prognostic impact of on-hours vs off-hours admission and the efficacy of ELCS according to the timing of hospital admission time in AMI-CS. - Methods - Patients with AMI-CS enrolled in the multicenter, randomized ECLS-SHOCK trial from 2019 to 2022 were included. The prognosis of patients admitted during regular hours (ie, on-hours) was compared to patients admitted during off-hours. Thereafter, the prognostic impact of ECLS was investigated stratified by the timing of hospital admission. The primary endpoint was 30-day all-cause mortality. Statistical analyses included Kaplan-Meier, univariable, and multivariable logistic regression analyses. - Results - Of 417 patients enrolled in the ECLS-SHOCK trial, 48.4% (n = 202) were admitted during off-hours. Patients admitted during off-hours were younger (median age = 62 years [Q1-Q3: 55-69 years] vs 63 years [Q1-Q3: 58-71 years]; P = 0.036) and more commonly treated using initial femoral access for coronary angiography (79.0% [n = 158/200] vs 67.9% [n = 146/215]; P = 0.011). However, off-hours admission was not associated with an increased risk of 30-day all-cause mortality (off-hours vs on-hours: 46.0% [n = 93/202] vs 50.7% [n = 109/215]; OR: 0.83; 95% CI: 0.56-1.22). Furthermore, ECLS had no prognostic impact on 30-day all-cause mortality in patients with AMI-CS admitted during on-hours (50.5% [n = 52/103] vs 50.9% [n = 57/112]; P = 0.95; OR: 0.98; 95% CI: 0.58-1.68) or in patients admitted during off-hours (45.3% [n = 48/106] vs 46.9% [n = 45/96]; P = 0.82; OR: 0.94; 95% CI: 0.54-1.63). Finally, ECLS was associated with an increased risk of bleeding events, especially in patients admitted during on-hours. - Conclusions - The prognosis in AMI-CS was not affected by admission time with a similar effect of ECLS during on- and off-hours. |
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| Item Description: | Online verfügbar: 14. Oktober 2024, Artikelversion: 14. Oktober 2024 Gesehen am 13.05.2025 |
| Physical Description: | Online Resource |
| ISSN: | 1876-7605 |
| DOI: | 10.1016/j.jcin.2024.08.013 |