Abstract 4343393: Impact of adverse events on clinical outcomes in patients with cardiogenic shock supported by temporary mechanical circulatory support devices

Abstract

Introduction: Temporary mechanical circulatory support (tMCS) devices are often used in patients with cardiogenic shock (CS). Whether tMCS device-related adverse events (DRAEs) affect patient outcomes is unclear. Aim: To assess whether DRAEs are associated with worse in-hospital outcomes in patients with CS. Methods: A retrospective chart review was conducted to identify patients with CS requiring tMCS at the Medical University of South Carolina from 8/2021 to 8/2023. Patients were stratified by presence/absence of a DRAE (occurring while on tMCS support or ≤48 hrs of tMCS removal). DRAE definitions were based on published guidelines and included bacteremia, bleeding, neurologic event, vascular injury, heparin induced thrombocytopenia and hemolysis. Outcomes included in-hospital death and “unfavorable outcome” (death prior to heart transplant, durable LVAD, or discharge). Multivariable logistic regression was performed to account for differences in baseline characteristics. Results: Among 268 patients included, 112 (41.8%) had a DRAE and 156 (58.2%) did not. The median (25 th , 75 th ) age was 60 (44, 67) years, 36.6% were Black, and 28.4% were female (p=NS between groups). Historical atrial fibrillation (AF) and HFrEF were more common in those with a DRAE than those without (34.0% vs 22.3%, p=0.04 for AF; 73.7% vs 54.5%, p<0.01 for HFrEF). Those with a DRAE had more advanced CS (stage D/E 72.3% vs 50.0%, p<0.01), more commonly had cardiac arrest prior to tMCS (23.2% v 9.6%, p<0.01), and more commonly were on ECMO (33.9% v 5.1%, p<0.01). The median hospital length of stay was 30 (18, 46) days, with no significant difference between groups. In the DRAE group, a total of 161 unique DRAEs occurred, with 48 patients experiencing >1 DRAE. The most common AE was bleeding, followed by hemolysis, and bacteremia ( Figure ). In-hospital death was more common in the DRAE group (32.1% vs 12.2%; unadjusted OR [95% CI] 3.42 [1.83-6.37]; p<0.01). Unfavorable outcome was also more common in the DRAE group (28.6% vs 10.9%, unadjusted OR 3.27 [1.71-6.26]; p<0.01) ( Figure ). These findings were consistent after adjustment for age, sex, history of HFrEF, history of AF, and ECMO exposure. Conclusion: The presence of a DRAE in patients with CS and tMCS is associated with a significantly higher in-hospital mortality and unfavorable outcome.