What is the clinical evidence from this study?

Study design: Cohort. Population: Acute myocardial infarction with cardiogenic shock (AMICS) (n=93). Intervention: Right heart catheterisation-derived congestion phenotyping vs. Comparison among congestion phenotypes (EuV, LV, RV, BiV). Primary outcome: Composite of all-cause mortality, acute kidney injury, acute liver injury, mechanical ventilation, or arrhythmia (p=0.707).

What does this research mean for the field?

Right ventricular congestion in acute myocardial infarction with cardiogenic shock is associated with a 42.9% all-cause mortality rate, significantly higher than other congestion phenotypes. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

The study evaluates the clinical impact of haemodynamic phenotypes in patients with acute myocardial infarction and cardiogenic shock.

February 6, 2026

Right heart catheterisation-derived haemodynamics in acute myocardial infarction with cardiogenic shock: classification and clinical outcomes

Key Result

Right ventricular congestion in AMICS was associated with the highest all-cause mortality (42.9%) compared to euvolemic (6.3%), left (8.3%), and biventricular (13.5%) congestion (p=0.017).

Key Points

The study evaluates the clinical impact of haemodynamic phenotypes in patients with acute myocardial infarction and cardiogenic shock.
Ninety-three patients with acute myocardial infarction and cardiogenic shock underwent right heart catheterisation.
Patients were classified based on right atrial pressure and pulmonary capillary wedge pressure into four congestion groups: euvolemic, left ventricular, right ventricular, and biventricular.
Clinical outcomes like mortality and acute organ injuries were analyzed across these groups.
The biventricular group had the highest right atrial pressure and pulmonary capillary wedge pressure.
Right ventricular congestion was associated with the highest all-cause mortality at 42.9%.
Overall mortality across congestion groups varied, with 62.2%–78.6% experiencing at least one adverse outcome.

Study Design

Type

Cohort (n=93)

Multicenter

Structured PICO

Does right heart catheterisation-derived congestion phenotyping predict clinical outcomes in patients with acute myocardial infarction with cardiogenic shock?

Population

93 patients with acute myocardial infarction with cardiogenic shock (AMICS) who underwent right heart catheterisation, mean age 54 ± 10 years, 94.6% male.

Intervention

Right heart catheterisation-derived haemodynamic phenotyping (classification into euvolemic, left ventricular, right ventricular, or biventricular congestion based on right atrial pressure and pulmonary capillary wedge pressure)

Comparator

Comparison among the four congestion phenotypes (euvolemic, left ventricular, right ventricular, and biventricular congestion)

Outcome

Composite outcome of all-cause mortality, acute kidney injury, acute liver injury, mechanical ventilation, or arrhythmiacomposite

In patients with acute myocardial infarction and cardiogenic shock, right ventricular congestion identified by right heart catheterisation is associated with the highest mortality, highlighting the value of haemodynamic phenotyping for risk stratification.

Main Result

p-value: p=0.707

Abstract

Abstract Background Acute myocardial infarction with cardiogenic shock (AMICS) is a life-threatening condition with high morbidity and mortality. Right heart catheterisation (RHC)-guided haemodynamic assessment enables classification of ventricular congestion patterns, which may have prognostic value. Purpose This study aimed to evaluate the clinical impact of different congestion phenotypes in AMICS based on RHC-derived right atrial pressure (RAP) and pulmonary capillary wedge pressure (PCWP). Methods Ninety-three patients with AMICS who underwent RHC at our center between 2018 and 2024 were classified as euvolemic (EuV), left ventricular congestion (LV), right ventricular congestion (RV), or biventricular congestion (BiV) based on RAP and PCWP. Baseline characteristics, hemodynamics, and clinical outcomes were compared among the groups. Results The cohort had a mean age of 54 ± 10 years, and 94.6% were male. Haemodynamic parameters varied significantly, with the BiV group exhibiting the highest RAP and PCWP. The primary composite outcome (all-cause mortality, acute kidney injury, acute liver injury, mechanical ventilation, or arrhythmia) occurred in 62.2%–78.6% of patients across congestion groups (p=0.707). All-cause mortality was highest in the RV group (42.9%) compared to EuV (6.3%), LV (8.3%), and BiV (13.5%) (p=0.017). Other outcomes, including acute kidney injury, acute liver injury, mechanical ventilation, and arrhythmia, were not significantly different among groups. Conclusion Among patients with AMICS, right ventricular congestion was associated with the highest mortality. Haemodynamic phenotyping via RHC may aid risk stratification and guide tailored management strategies.

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