Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2021, 165(3):291-297 | DOI: 10.5507/bp.2021.046

Regional differences in presentation characteristics, use of treatments and outcome of patients with cardiogenic shock: Results from multicenter, international registry

Michal Pazdernik^{a, b}, Mario Gramegna^c, Allan Bohm^{d, e}, Maria Trepa^f, Christophe Vandenbriele^g, Salvatore De Rosa^h, Jamol Uzokovⁱ, Milica Aleksic^j, Milana Jarakovic^k, Mohammad El Tahlawi^l, Morsy Mostafa^m, Maria Stratinakiⁿ, Diego Araiza-Garaygordobil^o, Ekaterina Gubareva^p, Polina Duplyakova^q, Manuel Chacon-Diaz^r, Hesham Refaat^{l, s}, Federico Guerra^t, Alberto Maria Cappelletti^c, Vojtech Berka^b, Dirk Westermann^u, Benedikt Schrage^u

Received: November 3, 2020; Revised: February 17, 2021; Accepted: July 9, 2021; Available online: August 19, 2021

^a Department of Cardiology, IKEM, Prague, Czech Republic

^b Department of Cardiology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic

^c Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy

^d National Cardiovascular Institute, Bratislava, Slovak Republic

^e 3rd Department of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic

^f Centro Hospitalar Universitario do Porto, Porto, Portugal

^g University Hospitals Leuven, Leuven, Belgium

^h Magna Graecia University, Catanzaro, Italy

ⁱ Republican Specialized Scientific Practical Medical Center of Therapy and Medical Rehabilitation, Tashkent, Uzbekistan

^j Clinical Hospital Center Bezanijska Kosa, Belgrade, Serbia

^k Institute for Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia

^l Cardiology Department, Zagazig University Hospital, Zagazig, Egypt

^m As-Salam International Hospital, Cairo, Egypt

ⁿ Onassis Cardiac Surgery Centre, Athens, Greece

^o Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico

^p Clinics of Samara State Medical University, Samara, Russian Federation

^q Samara State Cardiology Dispensary, Samara, Russian Federation

^r Instituto Nacional Cardiovascular-INCOR, Lima, Peru

^s Al Jahra Hospital, Al Jahra, Kuwait

^t Marche Polytechnic University, University Hospital "Umberto I - Lancisi - Salesi", Ancona, Italy

^u University Heart and Vasculature Centre, Hamburg, Germany

Background: Concurrent evidence about cardiogenic shock (CS) characteristics, treatment and outcome does not represent a global spectrum of patients and is therefore limited. The aim of this study was to investigate these regional differences.

Methods: To investigate regional differences in presentation characteristics, treatments and outcomes of patients treated with all types of cardiogenic shock (CS) in a single calendar year on a multi-national level. Consecutive patients from 19 tertiary care hospitals in 13 countries with CS who were treated between January 1, 2018 and December 31, 2018 were enrolled in this study.

Results: In total, 699 cardiogenic shock patients were included in this study. Of these patients, 440 patients (63%) were treated in European hospitals and 259 (37%) were treated in Non-European hospitals. Female patients (P<0.01) and patients with a previous myocardial infarction (P=0.02) were more likely to present at Non-European hospitals; whereas older patients (P=0.01) and patients with cardiogenic shock due to acute heart failure (P<0.01) were more likely to present at European hospitals. Vasopressor use was more likely in Non-European hospitals (P=0.04), whereas use of mechanical circulatory support (MCS) was more likely in European hospitals (P<0.01). Despite adjustment for relevant confounders, 30-day in-hospital mortality risk was comparably high in CS patients treated in European vs. Non-European hospitals (hazard ratio 1.08, 95% CI 0.84-1.39, P=0.56).

Conclusion: Despite marked heterogeneity in characteristics and treatment of CS patients, including fewer use of MCS but more frequent use of vasopressors in Non-European hospitals, 30-day in-hospital mortality did not differ between regions.

Keywords: Kew words: cardiogenic shock, regional differences, mechanical circulatory support, acute heart failure, AMICS

Received: November 3, 2020; Revised: February 17, 2021; Accepted: July 9, 2021; Prepublished online: August 19, 2021; Published: September 20, 2021  Show citation