Journal article
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, v 43(11), pp 1846-1856
Nov 2024
PMID: 38944132
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
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.
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Details
- Title
- Factors associated with acute limb ischemia in cardiogenic shock and downstream clinical outcomes: Insights from the Cardiogenic Shock Working Group
- Creators
- Ajar Kochar - Brigham and Women's HospitalSaraschandra Vallabhajosyula - Cardiovascular Institute of the SouthKevin John - Tufts Medical CenterShashank S. Sinha - Inova Fairfax HospitalMichele Esposito - Medical University of South CarolinaMohit Pahuja - University of Oklahoma Health Sciences CenterColin Hirst - HealthPartnersSong Li - Division of Cardiology, Institute for Advanced Cardiac Care, Medical City Healthcare, Dallas, TexasQiuyue Kong - Tufts Medical CenterBorui Li - Tufts Medical CenterPeter Natov - Tufts Medical CenterManreet Kanwar - Allegheny Health NetworkJaime Hernandez-Montfort - Baylor Scott & White HealthA. Reshad Garan - Beth Israel Deaconess Medical CenterKarol Walec - Tufts Medical CenterPeter Zazzali - Tufts Medical CenterPaavni Sangal - Tufts Medical CenterVan-Khue Ton - Massachusetts General HospitalElric Zweck - Heinrich Heine University DüsseldorfRachna Kataria - LifespanMaya Guglin - Indiana UniversityEsther Vorovich - Northwestern UniversitySandeep Nathan - University of ChicagoJacob Abraham - Providence CollegeNeil M. Harwani - Tufts Medical CenterJustin A. Fried - Columbia University Irving Medical CenterMaryjane Farr - The University of Texas Southwestern Medical CenterShelley A. Hall - Baylor Medical Center at GarlandGavin W. Hickey - University of Pittsburgh Medical CenterDetlef Wencker - Baylor Scott & White HealthAndrew D. Schwartzman - Maine Medical CenterWissam Khalife - The University of Texas Medical Branch at GalvestonClaudius Mahr - University of Washington Medical CenterJu H. Kim - Houston MethodistArvind Bhimaraj - Houston MethodistVanessa Blumer - Inova Fairfax HospitalAnthony Faugno - Tufts Medical CenterDaniel Burkhoff - Cardiovascular Research FoundationNavin K. Kapur - Tufts Medical Center
- Publication Details
- The Journal of heart and lung transplantation, v 43(11), pp 1846-1856
- Publisher
- Elsevier; NEW YORK
- Number of pages
- 11
- Grant note
- Abiomed Inc.Boston Scientific Inc.Abbott LaboratoriesGetinge Inc.LivaNova Inc.VerantosAbbottAbiomed Inc.
This work was supported by institutional grants from Abiomed Inc, Boston Scientific Inc, Abbott Laboratories, Getinge Inc, and LivaNova Inc to Tufts Medical Center. The sponsors had no input on collection, analysis, and interpretation of the data, nor in the preparation, review, or approval of the manuscript. Dr. Kochar has received institutional grant support from Shockwave Inc, Rampart Inc and consulting honoraria for Faraday Pharmaceuticals. Dr Kapur has received consulting honoraria and institutional grant support from Abbott Laboratories, Abiomed Inc, Boston Scientific, Medtronic, LivaNova, Getinge, and Zoll. Dr Kanwar has served on the advisory board for Abiomed Inc., Abbott Laboratories and CorWave. Dr Sinha has served as a consultant for Abiomed Inc. Dr Garan has served as a consultant for NuPulseCV, has been on the scientific advisory board for Abiomed, and is a recipient of research support from Verantos and Abbott. Dr Hernandez-Montfort has served as a consultant for Abiomed Inc. Dr Abraham has served as a consultant for Abbott Laboratories and Abiomed Inc. Dr Nathan has received consulting honoraria from Abiomed, Getinge, and CSI. Dr Hall has served as a consultant to Abiomed, Abbott, and Medtronic. Dr Mahr has served as a consultant to Abbott, Abiomed, and Syncaria. Dr Burkhoff has received an unrestricted, educational grant from Abiomed Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Cardiology
- Web of Science ID
- WOS:001351073900001
- Scopus ID
- 2-s2.0-85203259101
- Other Identifier
- 991021932195504721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Cardiac & Cardiovascular Systems
- Respiratory System
- Surgery
- Transplantation