TY - JOUR
T1 - Comparative Analysis of Patient Characteristics in Cardiogenic Shock Studies
T2 - Differences Between Trials and Registries
AU - Megaly, Michael
AU - Buda, Kevin
AU - Alaswad, Khaldoon
AU - Brilakis, Emmanouil S.
AU - Dupont, Allison
AU - Naidu, Srihari
AU - Ohman, Magnus
AU - Napp, L. Christian
AU - O'Neill, William
AU - Basir, Mir B.
N1 - Funding Information:
Dr Basir is a consultant/speaker for Abbott Vascular, Abiomed, Cardiovascular Systems, Chiesi, Procyrion, and Zoll. Dr Alaswad has received honoraria for consulting/speaking from Boston Scientific, Cardiovascular Systems Inc, LivaNova, and Teleflex. Dr Brilakis has received honoraria for consulting/speaking from Abbott Vascular, American Heart Association (associate editor Circulation), Amgen, Biotronik, Boston Scientific, Cardiovascular Innovations Foundation (Board of Directors), ControlRad, Cardiovascular Systems Inc, Ebix, Elsevier, GE Healthcare, InfraRedx, Medtronic, Siemens, and Teleflex; has received research support from Regeneron and Siemens; and is a shareholder of MHI Ventures. Dr Napp has received honoraria for lecturing/consulting and has received research support from Cytosorbents; has received honoraria for lecturing from Abbott and Maquet; and has received honoraria for lecturing/proctoring/consulting and research funding from Abiomed. Dr O’Neill is a consultant/speaker for Abbott Vascular, Abiomed, Boston Scientific, Edwards, and Zoll. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2022 American College of Cardiology Foundation
PY - 2022/2/14
Y1 - 2022/2/14
N2 - Objectives: This study sought to evaluate the differences in cardiogenic shock patient characteristics in trial patients and real-life patients. Background: Cardiogenic shock (CS) is a leading cause of mortality in patients presenting with acute myocardial infarction (AMI). However, the enrollment of patients into clinical trials is challenging and may not be representative of real-world patients. Methods: We performed a systematic review of studies in patients presenting with AMI-related CS and compared patient characteristics of those enrolled into randomized controlled trials (RCTs) with those in registries. Results: We included 14 RCTs (n = 2,154) and 12 registries (n = 133,617). RCTs included more men (73% vs 67.7%, P < 0.001) compared with registries. Patients enrolled in RCTs had fewer comorbidities, including less hypertension (61.6% vs 65.9%, P < 0.001), dyslipidemia (36.4% vs 53.6%, P < 0.001), a history of stroke or transient ischemic attack (7.1% vs 10.7%, P < 0.001), and prior coronary artery bypass graft surgery (5.4% vs 7.5%, P < 0.001). Patients enrolled in RCTs also had lower lactate levels (4.7 ± 2.3 mmol/L vs 5.9 ± 1.9 mmol/L, P < 0.001) and higher mean arterial pressure (73.0 ± 8.8 mm Hg vs 62.5 ± 12.2 mm Hg, P < 0.001). Percutaneous coronary intervention (97.5% vs 58.4%, P < 0.001) and extracorporeal membrane oxygenation (11.6% vs 3.4%, P < 0.001) were used more often in RCTs. The in-hospital mortality (23.9% vs 38.4%, P < 0.001) and 30-day mortality (39.9% vs 45.9%, P < 0.001) were lower in RCT patients. Conclusions: RCTs in AMI-related CS tend to enroll fewer women and lower-risk patients compared with registries. Patients enrolled in RCTs are more likely to receive aggressive treatment with percutaneous coronary intervention and extracorporeal membrane oxygenation and have lower in-hospital and 30-day mortality.
AB - Objectives: This study sought to evaluate the differences in cardiogenic shock patient characteristics in trial patients and real-life patients. Background: Cardiogenic shock (CS) is a leading cause of mortality in patients presenting with acute myocardial infarction (AMI). However, the enrollment of patients into clinical trials is challenging and may not be representative of real-world patients. Methods: We performed a systematic review of studies in patients presenting with AMI-related CS and compared patient characteristics of those enrolled into randomized controlled trials (RCTs) with those in registries. Results: We included 14 RCTs (n = 2,154) and 12 registries (n = 133,617). RCTs included more men (73% vs 67.7%, P < 0.001) compared with registries. Patients enrolled in RCTs had fewer comorbidities, including less hypertension (61.6% vs 65.9%, P < 0.001), dyslipidemia (36.4% vs 53.6%, P < 0.001), a history of stroke or transient ischemic attack (7.1% vs 10.7%, P < 0.001), and prior coronary artery bypass graft surgery (5.4% vs 7.5%, P < 0.001). Patients enrolled in RCTs also had lower lactate levels (4.7 ± 2.3 mmol/L vs 5.9 ± 1.9 mmol/L, P < 0.001) and higher mean arterial pressure (73.0 ± 8.8 mm Hg vs 62.5 ± 12.2 mm Hg, P < 0.001). Percutaneous coronary intervention (97.5% vs 58.4%, P < 0.001) and extracorporeal membrane oxygenation (11.6% vs 3.4%, P < 0.001) were used more often in RCTs. The in-hospital mortality (23.9% vs 38.4%, P < 0.001) and 30-day mortality (39.9% vs 45.9%, P < 0.001) were lower in RCT patients. Conclusions: RCTs in AMI-related CS tend to enroll fewer women and lower-risk patients compared with registries. Patients enrolled in RCTs are more likely to receive aggressive treatment with percutaneous coronary intervention and extracorporeal membrane oxygenation and have lower in-hospital and 30-day mortality.
KW - cardiogenic shock
KW - randomized controlled trials
KW - real-world data
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U2 - 10.1016/j.jcin.2021.11.036
DO - 10.1016/j.jcin.2021.11.036
M3 - Article
C2 - 35144785
AN - SCOPUS:85123734598
SN - 1936-8798
VL - 15
SP - 297
EP - 304
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 3
ER -