Chest. 2023 Aug 12:S0012-3692(23)05270-4. doi: 10.1016/j.chest.2023.08.011. Online ahead of print.
BACKGROUND: Related to ongoing demographic changes, the spectrum of patients with cardiogenic shock (CS) has significantly changed and more patients develop CS in the absence of acute myocardial infarction (AMI). However, these patients were typically excluded from prior studies. Very limited data regarding the prognostic role of CS onset and hospital admission is available.
RESEARCH QUESTION: Does the timing of CS occurrence (CS on admission (i.e., primary CS) or CS onset during hospitalization (i.e., secondary CS), as well as the hospital admission time (i.e., on- versus off-hours admission) affect the risk of 30-day all-cause mortality in patients with CS?
STUDY DESIGN AND METHODS: Consecutive patients with CS of any cause from 2019 to 2021 were included at one institution. First, the prognosis of patients with CS on admission was compared to patients with CS onset during hospitalization (i.e., primary versus secondary CS). Thereafter, prognosis of patients admitted during on-hours was compared to patients admitted during off-hours. Statistical analyses included Kaplan-Meier, uni- and multivariable Cox regression analyses.
RESULTS: 273 CS patients were included (64% primary CS). Although secondary CS was not associated with increased risk of all-cause mortality within the entire study cohort (HR = 1.532; 95% CI 0.990 - 2.371; p = 0.06), increased risk of 30-day all-cause mortality was specifically seen in patients with AMI-CS and secondary CS (HR = 2.087; 95% CI 1.126- 3.868; p = 0.02). Furthermore, patients admitted during off-hours were associated with improved risk of all-cause mortality compared to patients admitted during on-hours (HR = 0.497; 95% CI 0.302 - 0.817; p = 0.01), which was observed irrespective of AMI- and non-AMI-CS.
INTERPRETATION: Primary and secondary CS were associated with comparable risk of 30-day all-cause mortality in patients with CS, however, off-hours admission was independently associated with improved risk of 30-day all-cause mortality in patients with CS.