Ajar Kochar, Saraschandra Vallabhajosyula, Kevin John, Shashank S Sinha, Michele Esposito, Mohit Pahuja, Colin Hirst, Song Li, Qiuyue Kong, Borui Li, Peter Natov, Manreet Kanwar, Jaime Hernandez-Montfort, A Reshad Garan, Karol Walec, Peter Zazzali, Paavni Sangal, Van-Khue Ton, Elric Zweck, Rachna Kataria, Maya Guglin, Esther Vorovich, Sandeep Nathan, Jacob Abraham, Neil M Harwani, Justin A Fried, Maryjane Farr, Shelley A Hall, Gavin W Hickey, Detlef Wencker, Andrew D Schwartzman, Wissam Khalife, Claudius Mahr, Ju H Kim, Arvind Bhimaraj, Vanessa Blumer, Anthony Faugno, Daniel Burkhoff, Navin K Kapur
{"title":"Factors associated with acute limb ischemia in cardiogenic shock and downstream clinical outcomes: Insights from the Cardiogenic Shock Working Group.","authors":"Ajar Kochar, Saraschandra Vallabhajosyula, Kevin John, Shashank S Sinha, Michele Esposito, Mohit Pahuja, Colin Hirst, Song Li, Qiuyue Kong, Borui Li, Peter Natov, Manreet Kanwar, Jaime Hernandez-Montfort, A Reshad Garan, Karol Walec, Peter Zazzali, Paavni Sangal, Van-Khue Ton, Elric Zweck, Rachna Kataria, Maya Guglin, Esther Vorovich, Sandeep Nathan, Jacob Abraham, Neil M Harwani, Justin A Fried, Maryjane Farr, Shelley A Hall, Gavin W Hickey, Detlef Wencker, Andrew D Schwartzman, Wissam Khalife, Claudius Mahr, Ju H Kim, Arvind Bhimaraj, Vanessa Blumer, Anthony Faugno, Daniel Burkhoff, Navin K Kapur","doi":"10.1016/j.healun.2024.06.012","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>There are limited data depicting the prevalence and ramifications of acute limb ischemia (ALI) among cardiogenic shock (CS) patients.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":6.4000,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Heart and Lung Transplantation","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.healun.2024.06.012","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: There are limited data depicting the prevalence and ramifications of acute limb ischemia (ALI) among cardiogenic shock (CS) patients.
Methods: 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.
Results: 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).
Conclusions: 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.
期刊介绍:
The Journal of Heart and Lung Transplantation, the official publication of the International Society for Heart and Lung Transplantation, brings readers essential scholarly and timely information in the field of cardio-pulmonary transplantation, mechanical and biological support of the failing heart, advanced lung disease (including pulmonary vascular disease) and cell replacement therapy. Importantly, the journal also serves as a medium of communication of pre-clinical sciences in all these rapidly expanding areas.