Research Fellow Lenox Hill Hospital - Northwell Health Lenox Hill Hospital - Northwell Health New York, New York, United States
Disclosure(s):
Abduljabar Adi, MD: No financial relationships to disclose
Background: Fever in acute myocardial infarction (AMI)-related Cardiogenic shock (CS) may result from a systemic inflammatory response, which could be confused with infection. The prevalence of fever in this population as well as the factors associated with its incidence and its impact on outcomes have not been previously described.
Methods: The Northwell-Shock Registry is a multi-center, retrospective observational study of adult patients treated for CS at 11 hospitals in the New York metropolitan area between January 2016 and August 2022. Patients with CS secondary to AMI were included in this analysis and divided into Fever and No-Fever groups. Fever was defined as having a temperature of ≥38.0°C at any time during hospitalization. Antibiotic use was defined as continuous antibiotic administration for >24 hours.
Outcome: Of the 1,493 patients analyzed, 584 (39%) developed fever. Patients with fever were younger (68 ± 13 vs. 70 ± 13 years, p< 0.01), more frequently had leukocytosis on admission (79% vs. 61%, p< 0.01) and had longer hospital stays (15 ± 16 vs. 10 ± 15 days, p< 0.01). Patients with fever also had higher SCAI shock stages, with more patients in the Fever group presenting with Stage D and progressing to maximum stages of D and E (p < 0.01).
Patients who developed fever were more frequently treated with MCS (68% vs. 59%, p< 0.01), including intra-aortic balloon pump (52% vs. 45%, p< 0.01) and Impella (23% vs. 18%, p=0.04) but not ECMO. They also more frequently received mechanical ventilation (62% vs. 47%, p< 0.01) and PAC (62% vs. 52%, p< 0.01) but similar rates of percutaneous coronary intervention.
Antibiotic use was high in both groups but was more common in the Fever group (66% vs. 46%, p< 0.01), with longer average durations of use (13 vs. 8 days, p=0.03). Blood cultures (67% vs. 41%; p< 0.01) and urine cultures (29% vs. 17%; p< 0.01) were performed more frequently in patients with fever but had similar positivity rates. Mortality was similar in both groups (32% vs. 32%; p=0.95).
Conclusion: Fever is highly prevalent in patients with AMI-CS and it is positively associated with more invasive management strategies and positive blood cultures and negatively associated with age. However, it seems to have no effect on mortality. Further research is needed into the impact of fever in this population.
