Abstract Background Cardiogenic shock (CS) is a condition in which cardiac output isn’t enough to meet organ demands. This can occur independently from blood pressure (BP) values, being more challenging to diagnose CS in the absence of hypotension. Purpose The aim of the study was to compare critical care support used and mortality outcomes in patients with classic CS versus normotensive CS. Methods A retrospective single-center study of patients admitted to an intensive cardiac unit with CS in 5 years was conducted (n = 175). Patients in cardiac arrest at admission were excluded (n = 34). Comorbidities, diagnosis, left ventricular ejection fraction (LVEF) and analytic data at admission, SCAI classification, critical care support and mortality at 30 days and 1 year were registered. Chi-square and Mann-Whitney tests were used to compare patients with classic versus normotensive CS (considered when BP was still equal to or above 90 mmHg). Results This study included 36 patients (25.5%) with classic CS, with a median BP of 80 10 mmHg, and 105 (74.5%) with normotensive CS, with a median BP of 112 30 mmHg. The two groups are characterized in table 1. There were no differences regarding comorbidities, diagnosis or LVEF at admission (almost half of the patients with severely reduced LVEF in both groups). SCAI classification was different between groups (p = 0.017): in classic CS almost half of the patients were in stage C (16 patients, 44%) and there were no patients in stage A; a wider distribution was verified in patients with normotensive CS 14 patients (13.3%) in stage A, 23 (21.9%) in stage B, 33 (31.4%) in stage C, 26 (24.8%) in stage D and 9 (8.6%) in stage E. Regarding analytic data, only creatinine was significantly different between patients with classic versus normotensive CS 1.5 [1.7 vs 1.2 0.9 mg/dL, p = 0.025]. Lactate levels were higher in classic CS but without statistically significant differences (3.2 6 vs 2.3 3 U/L, p = 0.060). Noradrenaline use tended to be higher in patients with classic CS 33 (92%) vs 79 (75%), p = 0.054 but there were no statistically significant differences regarding critical care support use. Mechanical circulatory support, mechanical ventilation and renal replacement therapy were used similarly in classic and normotensive CS. Mortality outcomes at 30 days and 1 year were similar between groups. Conclusion This study highlights the similarities in mortality and critical care support between classic and normotensive cardiogenic shock, despite differences in SCAI classification and creatinine levels. It underscores the importance of early recognition and adequate management of CS, even in the absence of hypotension at presentation.
Almeida et al. (Fri,) studied this question.