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1Hospital N.S. Rosario, Cardiology - Barreiro - Portugal
2Sao Joao Hospital, Intensive Care - Porto - Portugal
3Sao Joao Hospital, Cardiology - Porto - Portugal
Background: Cardiogenic shock (CS) remains the major cause of death in acute coronary syndrome, and the presence of a previous cardiac dysfunction can influence the outcome. Purpose: Evaluate the impact of previous cardiomyopathy in CS and the predictors of mortality in CS patients. Methods: Single-centre retrospective study, engaging patients hospitalized for CS between 1/04/2016-31/10/2018. Multiple linear regression was performed to assess predictors of mortality at admission in CS patients. Then, patients were divided in two groups: A - previous cardiomyopathy in CS, and B - CS without a history of cardiomyopathy. Chi-square, Fisher and T-student tests were used to compare categorical and continuous variables. Results: 214 patients were included, mean age 62.36±13.92 years, with 78.5% males. Arterial hypertension (AH) (53.3%), dyslipidaemia (DL) (46.7%) and smokers (31.6%) are the most frequent comorbidities. Beta blockers (BB) (31.6%), Angiotensin-Converting-Enzyme inhibitor (ACEI) (40.9%) and platelet antiaggregant (PA) (30.8%) are frequent medications before the CS occurrence. Multiple linear regression revealed age, AH, and ACEI as predictors of CS mortality with an R2a of 0.096 – Table 1. In the group A (50 patients) the most prevalent aetiologies were ischemic (50%), valvular (24%) and alcoholic (12%). The groups were similar regarding gender, AH, DL, diabetes, obesity, values of cardiac troponins, creatinine and platelet count, arterial pressure and arrhythmias at admission and mortality rates. Group A were older (66.34±15.49 vs 61.15±13.22 years, p=0.021), use more cardiovascular medication, BB (81 vs 15.7%, p?0.001), ACEI (60 vs 34.8%, p=0.002), spironolactone (24 vs 4.4%, p?0.001), furosemide (40 vs 11.9%, p?0.001) and PA (53.1 vs 23.9%, p?0.001); at admission presented lower values of haemoglobin (12.39±2.44 vs 13.46±2.24, p=0.008) and leukocytes (13.02±10.27 vs 15.4±7.7, p=0.043). Group B had more angiography performed (84.8 vs 64%, p=0.001), and less time until the angiography (3±3 vs 3.5±2.88 hours, p=0.001) and higher left ventricular ejection fraction (35.64±13.59 vs 28.22±14.07, p=0.02). Linear regression confirmed that previous cardiomyopathy did not influence the mortality rates in CS patients, p=0.612. Conclusions: Age and AH are the major predictors of mortality in CS and the use of ACEI seems have a protective effect.
β (95% CI)
0.205 (0.002 - 0.013)
0.230 (0.067 - 0.390)
-0.252 (-0.409 - -0.100)
Multiple linear regression models for prediction of mortality in cardiogenic shock.
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