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Cardiac arrest predictors in cardiogenic shock

Session Poster Session 3

Speaker Helder Santos

Event : Heart Failure 2019

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease: Treatment, Revascularization
  • Session type : Poster Session

Authors : H Santos (Barreiro,PT), T Vieira (Porto,PT), J Fernandes (Porto,PT), R Pinto (Porto,PT), T Filipa (Porto,PT), AR Ferreira (Porto,PT), M Rios (Porto,PT), T Honrado (Porto,PT)

H Santos1 , T Vieira2 , J Fernandes2 , R Pinto3 , T Filipa3 , AR Ferreira2 , M Rios2 , T Honrado2 , 1Hospital N.S. Rosario, Cardiology - Barreiro - Portugal , 2Sao Joao Hospital, Intensive Care - Porto - Portugal , 3Sao Joao Hospital, Cardiology - Porto - Portugal ,


Background: Cardiac arrest (CA) is a defining moment to patient outcome. Cardiogenic shock (CS) is the cardiovascular emergency with more mortality rates, and CA is considerably more frequent in these patients. Combined, CS and CA, are a potentially lethal event.

Purpose: Evaluate the impact of cardiovascular previous history, clinical signs and diagnosis procedures at admission in the prediction of CA in CS patients.

Methods: Single-centre retrospective study, engaging patients hospitalized for CS between 1/01/2014-31/10/2018. Epidemiological, clinical data at admission and diagnosis procedure’s results were collected. Chi-square, Fisher and T-student tests were used to compare categorical and continuous variables. Logistic regression was performed to assess CA occurrence based on the cardiovascular history, clinical signs and diagnostic tools at admission.

Results: 218 patients were included, mean age 62.34±13.90 years, with 68% males. Patients that suffer CA (134 patients) were similar regarding age, gender, body mass index, arterial hypertension, dyslipidemia, previous ACS and arterial pressure at admission. Active smoking status was more frequent in CA (47 vs 32.1%, p=0.03), on other hand diabetes (20.1 vs 34.5%, p=0.018) and previous cardiomyopathy (23.1 vs 38.1%, p=0.018) were less prevalent that in non-CA patients. Beta blockers (43.9 vs 23.9%, p=0.002), angiotensin-converting-enzyme inhibitor (50.6 vs 34.6, p=0.021), furosemide (25.6 vs 13.4%, p=0.018) and platelet antiaggregants (41.5 vs 23.1%, p=0.004) are more frequent in non-CA patients. CA patients with CS had at admission lower values of pH (7.21±0.23 vs 7.39±0.10, p=0.009), however, higher lactate levels (6.5±6.45 vs 4.7±4.12, p?0.001) and de novo cardiac arrhythmias (23.1 vs 4.8, p?0.001). CA patients had less time until angiography performance (3.0±2.5 vs 5.0±4.5 hours, p?0.001), but better left ventricular ejection fraction (LVEF) (38.11±13.69 vs 25.43±6.43%, p=0.001). Logistic regression revealed LVEF (odds ratio (OR) 1.04, p=0.001, confidence interval (CI) 1.015-1.064) and de novo arrhythmia (OR 8.248, p=0.008, CI 2.38-28.63) as predictors of CA in CS patients.

Conclusions: LVEF and de novo arrhythmia at admission in CS were significant predictors of CA arrest.

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