Abstract 4143910: Comparative Outcomes of Cardiogenic Shock in Acute Myocardial Infarction Versus Acute Heart Failure: A Meta-Analysis

Introduction: Clinical trends show a rise in non-ischemic causes of cardiogenic shock (CS), especially acute heart failure CS (AHFCS). Compared to acute myocardial infarction cardiogenic shock (AMICS), AHFCS typically occurs in the context of chronic heart failure with compensatory mechanisms that seem to better withstand hemodynamic disturbances. Given the clinical heterogeneity, we aim to compare the in-hospital outcomes of AMICS and AHFCS to enhance clinical decision-making. Methods: We conducted a comprehensive literature search until April 2024 and included 8 studies from PubMed, Scopus, Embase, etc. We used Mantel-Haenszel random effects and inverse variance models to estimate the pooled risk ratio (RR) and mean differences at a 95% confidence interval. Results: Patients with AMICS were older by an average of 6.3 years compared to those with AHFCS [p<0.00001]. The AMICS cohort showed an 80% greater risk of using temporary mechanical circulatory support (tMCS) [RR: 1.80; p<0.00001] and an 88% greater risk of using > 1 tMCS [RR: 1.88; p<0.00001] than patients with AHFCS. When categorized by tMCS type, Impella use was notably higher in the AMICS group [RR: 1.65; p<0.0001]. AMICS patients showed a 79% lower risk of undergoing LVAD implantation [RR: 0.21; p=0.03] and 88% lower risk of heart transplantation (HT) [RR: 0.12; p<0.0001] compared to AHFCS cohort. Our meta-analysis revealed no significant differences between the two groups in hospital mortality [RR: 1.13; p = 0.50], length of stay (LOS), vasopressor use, or occurrence of bleeding. Conclusion: This pioneering meta-analysis reveals distinct differences in treatment approaches between AMICS and AHFCS. AMICS patients more frequently utilized tMCS but were less likely to receive LVAD or HT. Despite these variations, in-hospital mortality, LOS, vasopressor use, and bleeding remain comparable between the two groups. This emphasizes the critical need for tailored treatment strategies based on CS etiology.