Beyond hemodynamic failure: a distinct inflammatory cytokine profile in cardiogenic shock complicating acute coronary syndrome

OBJECTIVE: To compare the clinical, hemodynamic, metabolic and inflammatory profiles of patients with acute coronary syndrome (ACS) with and without cardiogenic shock (CS) and to identify biomarkers associated with disease severity. METHODS: In this observational study, 76 patients with ACS (38 with CS and 38 without CS) were enrolled. Clinical characteristics, laboratory parameters, cardiac biomarkers, lipid profile and 13 circulating cytokines were assessed. Continuous variables were compared using Welch's t-test or the Mann-Whitney U test and categorical variables using the chi-square or Fisher's exact test. Exploratory multivariable analyses adjusted for age, sex and STEMI status were performed for selected cytokines. RESULTS: Compared with patients without CS, those with CS had significantly lower blood pressure, higher shock index, reduced ejection fraction and higher CK-MB, troponin I, BNP, D-dimer, CRP, LDH, urea and liver enzyme levels. IL-8, IL-1β, IL-18, TNF-α and GM-CSF were significantly elevated in unadjusted analyses. After adjustment for age, sex and STEMI status, IL-8, IL-18 and IL-1β remained significantly associated with CS. Mortality was numerically higher in the CS group. CONCLUSION: ACS complicated by CS was associated with profound hemodynamic impairment, greater myocardial injury and an enhanced inflammatory response. These exploratory findings warrant confirmation in larger prospective studies.