{Reference Type}: Journal Article
{Title}: Factors associated with Acute Limb Ischemia in Cardiogenic Shock and downstream Clinical Outcomes: Insights from the Cardiogenic Shock Working Group.
{Author}: Kochar A;Vallabhajosyula S;John K;Sinha SS;Esposito M;Pahuja M;Hirst C;Li S;Kong Q;Li B;Natov P;Kanwar M;Hernandez-Montfort J;Garan R;Walec K;Zazzali P;Sangal P;Ton VK;Zweck E;Kataria R;Guglin M;Vorovich E;Nathan S;Abraham J;Harwani NM;Hickey GW;Wencker D;Schwartzman AD;Khalife W;Mahr C;Kim JH;Bhimaraj A;Blumer V;Faugno A;Burkhoff D;Kapur NK;
{Journal}: J Heart Lung Transplant
{Volume}: 0
{Issue}: 0
{Year}: 2024 Jun 27
{Factor}: 13.569
{DOI}: 10.1016/j.healun.2024.06.012
{Abstract}: <B>BACKGROUND: </B>There are limited data depicting the prevalence and ramifications of acute limb ischemia (ALI) among cardiogenic shock (CS) patients.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>There were 7,070 patients with CS and 399 (5.6%) developed ALI. Patients with ALI were more likely to be female (40.4% versus 29.4%) and have peripheral arterial disease (13.8% versus 8.3%). Stratified by maximum 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 VA-ECMO patients (11.6%) or VA-ECMO + 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).<BR><B>CONCLUSIONS: </B>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.