Key result
VA-triggered cardiogenic shock matches other triggers in 1-year mortality but involves more transplants and VADs.
Why the study?
Cardiogenic shock carries a poor prognosis, but whether ventricular arrhythmia as a trigger worsens prognosis compared to non-ventricular arrhythmia triggers remains unclear.
Does ventricular arrhythmia as a trigger for cardiogenic shock worsen 1-year outcomes compared to non-VA triggers?
Observational (n=769)
Yes
Does ventricular arrhythmia as a trigger for cardiogenic shock worsen 1-year outcomes compared to non-VA triggers?
Effect estimate: HR 0.94 (95% CI 0.67-1.30)
Absolute Event Rate: 42.6% vs 45.3%
p-value: p=0.7
Ventricular arrhythmia-triggered cardiogenic shock has similar 1-year mortality to other triggers but leads to a significantly higher need for heart transplantation and ventricular assist devices.
VA-triggered CS warrants similar acute risk stratification as other triggers; leaves open whether trigger-specific interventions reduce advanced therapy needs.
Background Cardiogenic shock (CS) is a life-threatening condition carrying poor prognosis, potentially triggered by ventricular arrhythmia (VA). Whether the occurrence of VA as trigger of CS worsens the prognosis compared to non-VA triggers remains unclear. The aim of this study was to evaluate 1-year outcomes [mortality, heart transplantation, ventricular assist devices (VAD)] between VA-triggered and non-VA-triggered CS. Methods FRENSHOCK is a prospective multicenter registry including 772 CS patients from 49 centers. One to three triggers can be identified in the registry (ischemic, mechanical complications, ventricular/supraventricular arrhythmia, bradycardia, iatrogenesis, infection, non-compliance). Baseline characteristics, management and 1-year outcomes were analyzed according to the VA-trigger in the CS population. Results Within 769 CS patients included, 94 were VA-triggered (12.2%) and were compared to others. At 1 year, although there was no mortality difference [42.6 vs. 45.3%, HR 0.94 (0.67–1.30), p = 0.7], VA-triggered CS resulted in more heart transplantations and VAD (17 vs. 9%, p = 0.02). Into VA-triggered CS group, though there was no 1-year mortality difference between ischemic and non-ischemic cardiomyopathies [42.5 vs. 42.6%, HR 0.97 (0.52–1.81), p = 0.92], non-ischemic cardiomyopathy led to more heart transplantations and VAD (25.9 vs. 5%, p = 0.02). Conclusion VA-triggered CS did not show higher mortality compared to other triggers but resulted in more heart transplantation and VAD at 1 year, especially in non-ischemic cardiomyopathy, suggesting the need for earlier evaluation by advanced heart failure specialized team for a possible indication of mechanical circulatory support or heart transplantation. Clinical trial registration https://clinicaltrials.gov , identifier NCT02703038.
No takes yet. Share an insight, caveat, or question.
Cherbi et al. (2023) conducted an observational in Cardiogenic shock (n=769). Ventricular arrhythmia-triggered cardiogenic shock vs. Non-ventricular arrhythmia-triggered cardiogenic shock was evaluated on 1-year all-cause mortality (HR 0.94, 95% CI 0.67-1.30, p=0.7). Ventricular arrhythmia-triggered cardiogenic shock did not significantly differ in 1-year mortality compared to other triggers (HR 0.94) but resulted in more heart transplantations and ventricular assist devices.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: