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Factors associated with acute limb ischemia in cardiogenic shock and downstream clinical outcomes: Insights from the Cardiogenic Shock Working Group

The Journal of Heart and Lung Transplantation, ISSN: 1053-2498, Vol: 43, Issue: 11, Page: 1846-1856
2024
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Researchers from Brigham and Women's Hospital Provide Details of New Studies and Findings in the Area of Cardiogenic Shock (Factors Associated With Acute Limb Ischemia In Cardiogenic Shock and Downstream Clinical Outcomes: Insights From the ...)

2024 DEC 10 (NewsRx) -- By a News Reporter-Staff News Editor at NewsRx Medical Devices Daily -- New research on Heart Disorders and Diseases -

Article Description

There are limited data depicting the prevalence and ramifications of acute limb ischemia (ALI) among cardiogenic shock (CS) patients. We employed data from the Cardiogenic Shock Working Group (CSWG), a consortium including 33 sites. We constructed a multi-variable logistic regression to examine the association between clinical factors and ALI, we generated another logistic regression model to ascertain the association of ALI with mortality. There were 7,070 patients with CS and 399 (5.6%) developed ALI. Patients with ALI were more likely to be female (40.4% vs 29.4%) and have peripheral arterial disease (13.8% vs 8.3%). Stratified by maximum society for cardiovascular angiography & intervention (SCAI) shock stage, the rates of ALI were stage B 0.0%, stage C 1.8%, stage D 4.1%, and stage E 10.3%. Factors associated with higher risk for ALI included: peripheral vascular disease OR 2.24 (95% CI: 1.53–3.23; p  < 0.01) and ≥2 mechanical circulatory support (MCS) devices OR 1.66 (95% CI: 1.24–2.21, p  < 0.01). ALI was highest for venous-arterial extracorporeal membrane oxygenation (VA-ECMO) patients (11.6%) or VA-ECMO + intra-aortic balloon pump (IABP)/Impella CP (16.6%) yet use of distal perfusion catheters was less than 50%. Mortality was 38.0% for CS patients without ALI but 57.4% for CS patients with ALI. ALI was significantly associated with mortality, adjusted OR 1.40 (95% CI 1.01–1.95, p  < 0.01). The rate of ALI was 6% among CS patients. Factors most associated with ALI include peripheral vascular disease and multiple MCS devices. The downstream ramifications of ALI were dire with a considerably higher risk of mortality.

Bibliographic Details

Kochar, Ajar; Vallabhajosyula, Saraschandra; John, Kevin; Sinha, Shashank S; Esposito, Michele; Pahuja, Mohit; Hirst, Colin; Li, Song; Kong, Qiuyue; Li, Borui; Natov, Peter; Kanwar, Manreet; Hernandez-Montfort, Jaime; Garan, A Reshad; Walec, Karol; Zazzali, Peter; Sangal, Paavni; Ton, Van-Khue; Zweck, Elric; Kataria, Rachna; Guglin, Maya; Vorovich, Esther; Nathan, Sandeep; Abraham, Jacob; Harwani, Neil M; Fried, Justin A; Farr, Maryjane; Hall, Shelley A; Hickey, Gavin W; Wencker, Detlef; Schwartzman, Andrew D; Khalife, Wissam; Mahr, Claudius; Kim, Ju H; Bhimaraj, Arvind; Blumer, Vanessa; Faugno, Anthony; Burkhoff, Daniel; Kapur, Navin K

Elsevier BV

Medicine

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