In patients with cardiogenic shock, 29% died during hospitalization; heart replacement therapies reduced mortality to 9%, with better survival in ADHF-CS than AMI-CS.
In patients with cardiogenic shock eligible for heart replacement therapies, those with acute decompensated heart failure have a better early prognosis and higher rates of heart replacement therapy utilization compared to those with acute myocardial infarction.
Absolute Event Rate: 0% vs 0%
Abstract Introduction Cardiogenic shock (CS) is a clinical syndrome characterized by low systemic output due to severe cardiac dysfunction, which can lead to multiorgan failure and death. Cardiac dysfunction can be acute (AMI-CS: acute myocardial infarction cardiogenic shock) or can derive from the destabilization of a chronic condition (ADHF-CS: acute decompensated heart failure cardiogenic shock). Despite advances in the management of CS, it remains associated with poor clinical outcomes, with a mortality rate ranging from 30% to 50%. Heart replacement therapies (HRT) contribute to improving the outcomes in selected patients. Purpose The aim of our study was to describe the epidemiology, clinical characteristics and treatment strategies adopted in a cohort of patients eligible for HRT at a tertiary referral center. We also aimed to identify clinical risk factors with prognostic significance and evaluate the role of HRT as prognostic modifiers. Methods In this obsevational retrospective cohort study we included adult patients who experienced CS between 2016 and 2024. Primary endpoint was total mortality at discharge. Results The study included 248 patients with a mean age of 56 years. 43% had AMI-CS, 57% had ADHF-CS. Clinical presentation at admission was CS in 71% of cases: 38% in SCAI C, 15% D and 18% E. 72 patients (29%) presented in SCAI A (9%) or B (20%) and developed shock during their hospital stay. SCAI B at hospitalization was more common in HF-CS (30 vs. 7%, p=0.001). T-MCS was implanted in 91% (226), with intra-aortic balloon pump (IABP) being the most frequently used (193, 85%) while ECMO and microaxial flow pumps were implanted in 29 (12%) and 4 (2%) patients, respectively. ECMO was used mainly in the ADHF-CS patients, IABP was more commonly used in AMI-CS patients. During hospitalization mortality among patients with CS was 29% (71) with 37 deaths occurring within the first 72 hours after diagnosis (15% of the total population, 52% of deaths due to shock). 32 patients (13%) received HT and 25 (10%) underwent LVAD implantation. Mortality of patients that underwent HRT was 9%. Overall survival at discharge was 69% (172). Mortality within the first 72 hours was higher in AMI-CS patients (22% vs. 9%; p = 0.0039), while there was a trend towards better survival in HF-CS (27% vs. 35%, p=0.1): these patients underwent HRT more frequently (35% vs. 6.5%; p 0.0001). At univariate analysis, age, diabetes, SCAI stage, renal function, pH, lactates and bicarbonates were predictors of death. Conclusions CS is still associated with high mortality rates and identifying risk factors correlated with prognosis is of primary importance. Patients with ADHF-CS had a better prognosis than those with AMI-CS but mortality remains high. Future efforts should focus on the implementation of standardized treatment protocols and monitoring systems to improve risk stratification, enable early intervention, and enhance survival rates in patients with CS.
Giovannelli et al. (Sat,) reported a other. In patients with cardiogenic shock, 29% died during hospitalization; heart replacement therapies reduced mortality to 9%, with better survival in ADHF-CS than AMI-CS.
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