Internal Medicine Resident Physician University of Texas Medical Branch Friendswood, Texas, United States
Disclosure(s):
Avery N. Love, DO: No financial relationships to disclose
Background: Cardiogenic shock in patients with aortic stenosis represents a high-risk clinical scenario with limited data guiding the timing of mechanical circulatory support (MCS). We evaluated whether early MCS use is associated with short-term outcomes in patients with aortic stenosis presenting with cardiogenic shock.
Methods: We performed a retrospective cohort study using the TriNetX Research Network, identifying adults (≥18 years) with cardiogenic shock and aortic stenosis, excluding acute or recent myocardial infarction. The index event was the first encounter meeting these criteria. Early MCS was defined as intra-aortic balloon pump, percutaneous ventricular assist device, or veno-arterial extracorporeal membrane oxygenation occurring on the index date or within two days. Propensity score matching (1:1 nearest-neighbor without replacement) was performed using demographics, comorbidities, and shock severity proxies including acute respiratory failure, endotracheal intubation, cardiac arrest, and ventricular arrhythmias. Outcomes were assessed at 30 days.
Outcome: Among 17,553 eligible patients with aortic stenosis and cardiogenic shock without myocardial infarction, 1,155 received early MCS within 0–2 days. After propensity score matching, 1,134 patients remained in each cohort. Thirty-day all-cause mortality was high and did not differ significantly between groups (Early MCS 40.21% vs No early MCS 37.92%; p=0.26). Acute kidney injury occurred less frequently in the Early MCS group (61.29% vs 65.96%; p=0.02). There were no significant differences in new hemodialysis/renal replacement therapy (23.28% vs 21.34%; p=0.92), bleeding requiring transfusion (28.40% vs 26.63%; p=0.35), or ischemic stroke (1.68% vs 1.68%; p=1.0).
Conclusion: In a propensity-matched cohort of patients with aortic stenosis and cardiogenic shock, early MCS within two days was not associated with lower 30-day mortality. Early MCS was associated with reduced acute kidney injury, without differences in dialysis, bleeding, or stroke. Further studies are needed to optimize patient selection and timing.
