Risk factors for postoperative myocardial injury-related cardiogenic shock in patients undergoing cardiac surgery

• Published in: Journal of cardiothoracic surgery Vol. 18; no. 1; p. 220
• Main Authors: Cheng, Xiao-Feng, Wang, Kuo, Zhang, Hai-Tao, Zhang, He, Jiang, Xin-Yi, Lu, Li-Chong, Chen, Cheng, Cheng, Yong-Qing, Wang, Dong-Jin, Li, Kai
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 06.07.2023; BioMed Central; BMC
• Subjects: Apheresis; Blood; Blood transfusions; Calcium channel blockers; Calcium channels; Cardiac patients; Cardiac surgery; Cardiogenic shock; Cardiopulmonary bypass; Cardiovascular disease; Catheters; Coronary artery bypass; Diabetes; Diabetes mellitus; Dopamine; Extracorporeal membrane oxygenation; Heart; Heart surgery; Insulin; Lactates; Medical research; Medicine, Experimental; Mortality; Myocardial injury; Outcomes; Oxygenation; Patients; Postoperative period; Pulmonary arteries; Regression analysis; Risk factors; Sex; Statistical analysis; Surgery; Troponin; Troponin T; Vasoactive agents; Ventricle; Cardiopulmonary bypass; Cardiac surgery; Cardiogenic shock; Outcomes; Myocardial injury
• DOI: 10.1186/s13019-023-02312-3
• ISSN: 1749-8090

Myocardial injury-related cardiogenic shock (MICS) is significantly associated with poor outcomes in patients after cardiac surgery. Herein, we aimed to investigate the risk factor for postoperative MICS. We performed a case-control study on 792 patients undergoing cardiac surgery from 2016 to 2019, including 172 patients with postoperative MICS and 620 age- and sex-matched controls. MICS was defined as composite criteria: a cardiac index of < 2.2 L/m /min, arterial lactate levels of > 5 mmol/L at the end of the surgery, a vasoactive-inotropic score of > 40 at the end of the surgery, and a cardiac troponin T (cTnT) level of > 0.8 µg/L on postoperative day 1 (POD1) with an increase of > 10% on POD 2. A total of 4671 patients who underwent cardiac surgery in our hospital between 2016 and 2019 were included; of these, 172 (3.68%) had MICS and the remaining 4499 did not. For investigating the risk factors, we selected 620 age- and sex-matched controls. In the univariate analysis, MICS was significantly associated with death (P < 0.05), extracorporeal membrane oxygenation (P < 0.05), continuous renal replacement therapy (P < 0.01), and ventricular arrhythmias (P < 0.05). Multivariable logistic regression analysis revealed that diabetes mellitus (OR:8.11, 95% CI: 3.52-18.66, P < 0.05) and a cardiopulmonary bypass (CPB) time of > 2 h (OR: 3.16, 95% CI: 1.94-5.15, P < 0.05) were associated with postoperative MICS. Moreover, long-time administration of preoperative calcium channel blocker (CCB) was associated with a less incidence of MICS (OR: 0.11, 95% CI: 0.05-0.27, P < 0.05). Postoperative MICS is significantly associated with poor outcomes. Diabetes mellitus and long CPB time are associated with MICS. Preoperative CCB administration is associated with less incidence of MICS.