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Publications

Journal Article Epublish 1 citation

PubMed: 42403523 DOI: 10.1016/j.aicoj.2026.100104

Age-associated outcomes in cardiogenic shock supported with microaxial flow pumps.

Ann Intensive Care 16:100104

Authors: Aurore Ughetto, Clement Delmas, Monika Fürholz, Laurent Bonello, Guillaume Leurent, Wiktor Kuliczkowski, Ana Hurtado, Philippe Gaudard, Chloé Tassain, François Xavier Herion, Agnieszka Tycinska, Benedikt Schrage, Marta Zaleska Kociecka, Frederic Bouisset, Matias Jacomet, Mikolaj Blaziak, Aneta Klotzka, Antoine Beurton, Miloud Cherbi

Affiliations

  • Department of Cardiothoracic Anaesthesia and Critical Care Medicine, Montpellier University Hospital, Montpellier, France.
  • INSERM, CNRS, Université de Montpellier, PHYMEDEXP, Montpellier, France.
  • Intensive Cardiac Care Unit, Cardiology Department, Rangueil University Hospital, Toulouse, France.
  • Recherche et Enseignement en Insuffisance Cardiaque Avancée, Assistance et Transplantation (REICATRA), Institut Saint Jacques, CHU de Toulouse, Toulouse, France.
  • Department of Cardiology, Inselspital, Bern, Switzerland.
  • Assistance Publique-Hôpitaux de Marseille, Department of Cardiology, Hôpital Nord, Marseille, France.
  • Department of Cardiology, University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France.
  • Institute of Heart Diseases, Faculty of Medicine, Wroclaw Medical University, Wrocław, Poland, University Hospital in Wroclaw, Wrocław, Poland.
  • Department of Critical Care, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.
  • CHU Bordeaux, Department of Cardiovascular Anesthesia and Critical Care, F-33000 Bordeaux, France.
  • Department of Intensive Cardiac Care, Medical University of Bilaystok, Poland.
  • German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
  • Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Heart Failure and Transplantation Department, Mechanical Circulatory Support and Transplant Department, National Institute of Cardiology, Warsaw, Poland.
  • Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland.
  • Univ. Bordeaux, INSERM, Biologie des Maladies Cardiovasculaires, U1034, F-336000, Pessac, France.

Abstract

BACKGROUND

Age represents a critical prognostic factor in cardiogenic shock (CS), yet older patients are underrepresented in randomized trials evaluating temporary mechanical circulatory support (tMCS). We aimed to assess the impact of age on outcomes in CS patients supported with micro-Axial Flow Pump (mAFP) across the age spectrum.

METHODS

We analyzed patients with CS treated with mAFP (Impella CP, 5.0 and 5.5) across 11 European centers between 2010 and 2023. Patients were stratified into quartiles by age: Q1 ≤ 52.0 years, Q2 > 52.0-60.0 years, Q3 > 60.0-69.0 years, and Q4 ≥ 69.0 years. The association between age and mortality was assessed using a Fine-Gray competing risks model and restricted cubic spline analysis. The primary endpoint was all-cause mortality at 30 days.

RESULTS

Among 1,043 patients supported with mAFP, the oldest quartile (Q4) was more frequently female, had higher comorbidity burden, and received less intensive support compared to Q1. In the Fine-Gray competing risks model, Q3 and Q4 patients had significantly higher 30-day and 1-year mortality risks (30-day: adjusted sHR 1.66 [95% CI: 1.19-2.34] and 1.87 [1.34-2.62]; 1-year: sHR 1.78 [1.31-2.41] and 2.08 [1.54-2.80]; Ptrend < 0.01 for all), with each additional year of age conferring a 3.2% increase in 30-day mortality risk (adjusted sHR 1.032 [1.017-1.047]). Major left ventricular ejection fraction (LVEF) recovery (≥10 percentage points) declined progressively with age, from 74.5% in Q1 to 41.9% in Q4 (p < 0.01), with each year associated with a 0.40 percentage-point reduction in LVEF improvement.

CONCLUSIONS

In this European registry, increasing age was associated with higher mortality and lower observed myocardial recovery among patients with cardiogenic shock supported with mAFP.

MeSH

Mortality, Shock, Cardiogenic, Recycling