Similar Outcomes in Cardiac Amyloid and Non-amyloid Patients Presenting with Cardiogenic Shock

Background: Despite increasing recognition of cardiac amyloidosis (CA) with advances in diagnostic techniques, clinical outcomes among CA patients who develop cardiogenic shock (CS) remain poorly characterized.

Methods: We conducted a retrospective analysis of patients with CS who received care at a single, high volume quaternary center between 2015-2022. Patients with CS and CA were identified utilizing ICD codes. Outcomes of interest included vasoactive-inotropic scores (VIS) at multiple timepoints, use of temporary mechanical circulatory support (tMCS), and inpatient mortality. VIS score was calculated as the mean value within 3 hours of specified time points (3, 6, 12, 18, and 24 hours) and within 6 hours for later time points (36, 48, 72, 84, 96 hours), with time zero indicating time in which patient entered cardiogenic shock. tMCS was defined as use of intra-aortic balloon pump, Impella (CP, 5.0, 5.5) and/or extracorporeal membrane oxygenation (ECMO). Endpoints were analyzed using Mann-Whitney U and Chi-square tests.

Outcome: Of 2,937 CS patients, 42 had CA. Overall, CA patients with CS were older (69.5 +/- 13.9 vs. 63.3 +/- 15.8 years, p=0.024) and had higher rates of cardiovascular comorbidities including hyperlipidemia, myocardial infarction and hypertension compared to non-CA patients with CS (p < 0.05). Both groups had similar use of tMCS, inpatient mortality, and similar VIS scores during the first 96 hours of CS, with the exception of the 6-hour timepoint (Table 1).

Conclusion: Despite greater comorbidity burden among CA patients in CS, there are comparable outcomes, including shock trajectory, use of tMCS, and inpatient mortality between CA and non-CA patients in CS. It is unclear if the difference in 6-hour VIS scores represents a difference in level of illness versus provider practice preferences.