Cardiogenic shock: incidence, survival and mechanical circulatory support usage 2007-2017-insights from a national registry.
Aged
Extracorporeal Membrane Oxygenation
/ statistics & numerical data
Female
Germany
Heart-Assist Devices
/ statistics & numerical data
Hospital Mortality
Hospitals, University
Humans
Incidence
Intra-Aortic Balloon Pumping
/ statistics & numerical data
Male
Registries
Shock, Cardiogenic
/ epidemiology
Survival Rate
Time Factors
Cardiogenic shock
ECMO
Mechanical circulatory support
pVAD
Journal
Clinical research in cardiology : official journal of the German Cardiac Society
ISSN: 1861-0692
Titre abrégé: Clin Res Cardiol
Pays: Germany
ID NLM: 101264123
Informations de publication
Date de publication:
Sep 2021
Sep 2021
Historique:
received:
10
07
2020
accepted:
11
11
2020
pubmed:
2
12
2020
medline:
13
1
2022
entrez:
1
12
2020
Statut:
ppublish
Résumé
A central element in the management of cardiogenic shock (CS) comprises mechanical circulatory support (MCS) systems to maintain cardiac output (CO). This study aims to quantify incidence, outcome and influence of MCS in CS over the last decade. All patients hospitalized with CS in a tertiary university hospital in Germany between 2007 and 2017 were identified utilizing the international coding system ICD-10 with code R57.0. Application of MCS was identified via German procedure classification codes (OPS). 383,983 cases of cardiogenic shock were reported from 2007 to 2017. Patients had a mean age of 71 years and 38.5% were female. The incidence of CS rose by 65.6% from 26,828 cases in 2007 (33.1 per 100,000 person-years, hospital survival 39.2%) to 44,425 cases in 2017 (53.7 per 100,000 person-years, survival 41.2%). In 2007, 16.0% of patients with CS received MCS (4.6 per 100,000 person-years, survival 46.6%), dropping to 13.9% in 2017 (6.6 per 100,000 person-years, survival 38.6%). Type of MCS changed over the years, with decreasing use of the intra-aortic balloon pump (IABP), an increase in extracorporeal membrane oxygenation (VA-ECMO) and percutaneous ventricular assist device (pVAD) usage. Significant differences regarding in-hospital survival were observed between the devices (survival: overall: 40.2%; medical treatment = 39.5%; IABP = 49.5%; pVAD = 36.2%; VA-ECMO = 30.5%; p < 0.001). The incidence of CS is increasing, but hospital survival remains low. MCS was used in a minority of patients, and the percentage of MCS usage in CS has decreased. The use rates of the competing devices change over time.
Sections du résumé
BACKGROUND
BACKGROUND
A central element in the management of cardiogenic shock (CS) comprises mechanical circulatory support (MCS) systems to maintain cardiac output (CO). This study aims to quantify incidence, outcome and influence of MCS in CS over the last decade.
METHODS
METHODS
All patients hospitalized with CS in a tertiary university hospital in Germany between 2007 and 2017 were identified utilizing the international coding system ICD-10 with code R57.0. Application of MCS was identified via German procedure classification codes (OPS).
RESULTS
RESULTS
383,983 cases of cardiogenic shock were reported from 2007 to 2017. Patients had a mean age of 71 years and 38.5% were female. The incidence of CS rose by 65.6% from 26,828 cases in 2007 (33.1 per 100,000 person-years, hospital survival 39.2%) to 44,425 cases in 2017 (53.7 per 100,000 person-years, survival 41.2%). In 2007, 16.0% of patients with CS received MCS (4.6 per 100,000 person-years, survival 46.6%), dropping to 13.9% in 2017 (6.6 per 100,000 person-years, survival 38.6%). Type of MCS changed over the years, with decreasing use of the intra-aortic balloon pump (IABP), an increase in extracorporeal membrane oxygenation (VA-ECMO) and percutaneous ventricular assist device (pVAD) usage. Significant differences regarding in-hospital survival were observed between the devices (survival: overall: 40.2%; medical treatment = 39.5%; IABP = 49.5%; pVAD = 36.2%; VA-ECMO = 30.5%; p < 0.001).
CONCLUSIONS
CONCLUSIONS
The incidence of CS is increasing, but hospital survival remains low. MCS was used in a minority of patients, and the percentage of MCS usage in CS has decreased. The use rates of the competing devices change over time.
Identifiants
pubmed: 33258007
doi: 10.1007/s00392-020-01781-z
pii: 10.1007/s00392-020-01781-z
pmc: PMC8405485
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1421-1430Informations de copyright
© 2020. The Author(s).
Références
Eur Heart J. 2019 Jan 7;40(2):87-165
pubmed: 30165437
Eur Heart J. 2019 Aug 21;40(32):2671-2683
pubmed: 31274157
N Engl J Med. 2018 Nov 1;379(18):1699-1710
pubmed: 30145971
Lancet. 2013 Nov 16;382(9905):1638-45
pubmed: 24011548
Am Heart J. 2011 May;161(5):871-7
pubmed: 21570516
JAMA. 2007 May 2;297(17):1883-91
pubmed: 17473298
Eur Heart J. 2018 Apr 1;39(13):1065-1074
pubmed: 29452351
Circulation. 2013 Jan 15;127(2):207-12
pubmed: 23224207
Eur Heart J. 2015 Sep 1;36(33):2246-56
pubmed: 26033984
PLoS One. 2018 May 10;13(5):e0196778
pubmed: 29746522
Am J Cardiol. 2018 Sep 15;122(6):1104-1110
pubmed: 30072134
Eur Heart J. 2018 Jan 7;39(2):119-177
pubmed: 28886621
N Engl J Med. 2017 Dec 21;377(25):2419-2432
pubmed: 29083953
Curr Opin Crit Care. 2019 Aug;25(4):391-396
pubmed: 31135393
JACC Cardiovasc Interv. 2018 Sep 24;11(18):1824-1833
pubmed: 30236355
Clin Res Cardiol. 2010 Mar;99(3):149-55
pubmed: 20033695
Eur J Heart Fail. 2015 May;17(5):501-9
pubmed: 25820680
JAMA. 2020 Feb 25;323(8):734-745
pubmed: 32040163
J Am Coll Cardiol. 2017 Jan 24;69(3):278-287
pubmed: 27810347
N Engl J Med. 2015 Dec 17;373(25):2438-47
pubmed: 26672846
Eur Heart J. 2016 Jul 14;37(27):2129-2200
pubmed: 27206819
JAMA. 2002 Mar 27;287(12):1541-7
pubmed: 11911756
Ther Clin Risk Manag. 2019 Jan 22;15:147-155
pubmed: 30774351
Eur J Heart Fail. 2019 Oct;21(10):1169-1186
pubmed: 31129923
Ann Intern Med. 2008 Nov 4;149(9):618-26
pubmed: 18981487
J Clin Med. 2020 Mar 28;9(4):
pubmed: 32231121
N Engl J Med. 2012 Oct 4;367(14):1287-96
pubmed: 22920912
Crit Care. 2019 Sep 18;23(1):320
pubmed: 31533785
Circ Heart Fail. 2019 Nov;12(11):e006635
pubmed: 31707801
N Engl J Med. 2017 May 25;376(21):2032-2042
pubmed: 28316276
Dtsch Med Wochenschr. 2013 Mar;138(12):603-7
pubmed: 23483424
J Am Heart Assoc. 2019 Apr 16;8(8):e011991
pubmed: 30947630
Eur J Heart Fail. 2014 Jul;16(7):729-36
pubmed: 24806352
Eur Heart J Acute Cardiovasc Care. 2018 Feb;7(1):16-27
pubmed: 29111770
Circulation. 2019 Mar 5;139(10):1249-1258
pubmed: 30586755
EuroIntervention. 2018 Apr 06;13(18):e2099-e2101
pubmed: 29624172
Eur Heart J. 2012 Oct;33(20):2535-43
pubmed: 22927559
Circ Heart Fail. 2013 Jan;6(1):23-30
pubmed: 23212552
Resuscitation. 2018 Jun;127:73-78
pubmed: 29626610
J Am Coll Cardiol. 2000 Sep;36(3 Suppl A):1063-70
pubmed: 10985706
Circ Heart Fail. 2012 Jan;5(1):25-35
pubmed: 21956192
Circulation. 2018 Nov 13;138(20):2298-2300
pubmed: 30571518
Clin Res Cardiol. 2018 May;107(5):371-379
pubmed: 29230546
Herz. 2018 Sep;43(6):512-517
pubmed: 29951945
Crit Care. 2019 Nov 29;23(1):385
pubmed: 31783891
Resuscitation. 2019 Oct;143:66-67
pubmed: 31401138
Am Heart J. 2015 Aug;170(2):353-61
pubmed: 26299234