1128 CLINICAL CHARACTERISTICS AND MANAGEMENT OF CARDIOGENIC SHOCK IN PATIENTS ELIGIBLE FOR CARDIAC TRANSPLANTATION AND LEFT VENTRICULAR ASSIST DEVICE
Authors: Napolitano Fiorenza Pia , Giovannelli Giada , Marcelli Chiara , Sabatino Mario , Spitaleri Giosafat , Masetti Marco , Suarez Sofia Martin , Corsini Anna , Galiè Nazzareno , Potena Luciano 
Published: December 2022

Abstract

Aims
to describe epidemiology, clinical characteristics and treatment modalities adopted in a cohort of patients eligible for cardiac transplantation or left ventricular assist device implantation admitted for cardiogenic shock atour center. Secondly, to identify clinical risk factors for in-hospital mortality to evaluate the role of surgical treatment options (cardiac transplantation and L-VAD implant) as modifiers of prognosis in this patient population.

Methods
We retrospectively identified discharge charts containing ICD-9 codes of cardiogenic shock (785.51) and IABP implantation (37.61) at our center in the period 2016-2021. Patients were considered eligible in the age rage 18-70 years old, according to the upper age limit of cardiac transplant and LVAD program. Patients presenting with cardiogenic shock after cardiac surgery, cardiogenic shock secondary to acute pulmonary embolism and acute aortic syndrome or patients needing IABP placement as preventive support for high-risk percutaneous or surgical myocardial revascularization procedures were excluded.

Results
163 patients were included in the study (mean age 56 years, 80% male). In this cohort of patients, the most common etiologies were represented by coronary artery disease (64% of patients) and cardiomyopathy (26% of patients), mostly idiopathic dilated forms followed by hypertrophic cardiomyopathy and cardiac amyloidosis. The remaining 10% of patients were affected by other forms of cardiac disease (which included acute myocarditis and cancer therapy-related CV toxicity). Diabetes mellitus and hypertension were the most common CV risks factors. Acute coronary syndrome was the underlying cause in 45% patients presenting with cardiogenic shock, while 56% of CS cases were due to acute decompensated heart failure not in the setting of ACS. Most patients (80%) were supported with IABP alone, while 10% needed cardiocirculatory support with ECMO. Regarding outcome, in-hospital mortality for CS was 30% (48 patients), while 36 patients (22%) underwent surgical treatment of heart failure with cardiac transplantation (21 patients) or L-VAD implantation (15 patients). Predictors of in-hospital mortality at univariate analysis were older age, lower eGFR at the time of shock (p=0,0001), persistence of elevated blood lactates &gt; 2 at CS presentation and at 24 hours (p=0,0001), and a failure to improve in renal impairment at 24 hours. Multivariate analysis identified lower eGFR and high lactates at 24 hours as independent risk factors for in-hospital mortality.

Conclusions
cardiogenic shock still remains a high-mortality condition. Mechanical circulatory support could provide stabilization and bridge to urgent cardiac transplantation and L-VAD implantation in order to improve prognosis. There is still need for diagnostic and therapeutic protocols standardized to improve the prognostic stratification and survival of patients with cardiogenic shock.