Prognostic Impact of Admission Time in Infarct-Related Cardiogenic Shock: An ECLS-SHOCK Substudy

JACC Cardiovasc Interv. 2024 Oct 14;17(19):2228-2239. doi: 10.1016/j.jcin.2024.08.013.

Abstract

Background: The outcomes of patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS) and the efficacy and safety of extracorporeal life support (ECLS) may be affected by the timing of hospital admission.

Objectives: The present ECLS-SHOCK substudy sought to investigate the prognostic impact of on-hours vs off-hours admission and the efficacy of ELCS according to the timing of hospital admission time in AMI-CS.

Methods: Patients with AMI-CS enrolled in the multicenter, randomized ECLS-SHOCK trial from 2019 to 2022 were included. The prognosis of patients admitted during regular hours (ie, on-hours) was compared to patients admitted during off-hours. Thereafter, the prognostic impact of ECLS was investigated stratified by the timing of hospital admission. The primary endpoint was 30-day all-cause mortality. Statistical analyses included Kaplan-Meier, univariable, and multivariable logistic regression analyses.

Results: Of 417 patients enrolled in the ECLS-SHOCK trial, 48.4% (n = 202) were admitted during off-hours. Patients admitted during off-hours were younger (median age = 62 years [Q1-Q3: 55-69 years] vs 63 years [Q1-Q3: 58-71 years]; P = 0.036) and more commonly treated using initial femoral access for coronary angiography (79.0% [n = 158/200] vs 67.9% [n = 146/215]; P = 0.011). However, off-hours admission was not associated with an increased risk of 30-day all-cause mortality (off-hours vs on-hours: 46.0% [n = 93/202] vs 50.7% [n = 109/215]; OR: 0.83; 95% CI: 0.56-1.22). Furthermore, ECLS had no prognostic impact on 30-day all-cause mortality in patients with AMI-CS admitted during on-hours (50.5% [n = 52/103] vs 50.9% [n = 57/112]; P = 0.95; OR: 0.98; 95% CI: 0.58-1.68) or in patients admitted during off-hours (45.3% [n = 48/106] vs 46.9% [n = 45/96]; P = 0.82; OR: 0.94; 95% CI: 0.54-1.63). Finally, ECLS was associated with an increased risk of bleeding events, especially in patients admitted during on-hours.

Conclusions: The prognosis in AMI-CS was not affected by admission time with a similar effect of ECLS during on- and off-hours.

Keywords: ECLS; acute myocardial infarction; admission time; cardiogenic shock; mortality; off-hour.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Comparative Study

MeSH terms

  • After-Hours Care
  • Aged
  • Extracorporeal Membrane Oxygenation* / adverse effects
  • Extracorporeal Membrane Oxygenation* / mortality
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / complications
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / mortality
  • Myocardial Infarction / therapy
  • Patient Admission*
  • Risk Assessment
  • Risk Factors
  • Shock, Cardiogenic* / diagnosis
  • Shock, Cardiogenic* / etiology
  • Shock, Cardiogenic* / mortality
  • Shock, Cardiogenic* / physiopathology
  • Shock, Cardiogenic* / therapy
  • Time Factors
  • Time-to-Treatment
  • Treatment Outcome