Key result
High-volume MCS center admission linked to ~13% lower mortality in cardiogenic shock.
Why the study?
The cross-volume effects of mechanical circulatory support and cardiac catheterization laboratory procedural volumes on outcomes of cardiogenic shock patients not receiving these interventions remain unexplored.
Does admission to hospitals with high volumes of mechanical circulatory support or cardiac catheterization laboratory procedures reduce in-hospital mortality in patients with cardiogenic shock?
Observational (n=130,822)
Yes
Does admission to hospitals with high volumes of mechanical circulatory support or cardiac catheterization laboratory procedures reduce in-hospital mortality in patients with cardiogenic shock?
Odds Ratio: 0.87 (95% CI 0.82–0.93)
Absolute Event Rate: 24.8% vs 30.7%
p-value: p=<0.001
High institutional mechanical circulatory support procedure volume, but not cardiac catheterization laboratory volume, is independently associated with lower in-hospital mortality for cardiogenic shock patients, supporting centralization of cardiogenic shock care.
Supports regionalization to high-volume MCS centers for cardiogenic shock; hypothesis-generating for centralization pending prospective trials.
Despite advancements in cardiogenic shock (CS) management, mortality remains high. While hospital volume has been linked to reduced mortality across myriad complex procedures, the cross-volume effects of mechanical circulatory support (MCS) and cardiac catheterization laboratory (CCL) procedures on CS patients not receiving these interventions remain unexplored. Using the 2016 to 2022 Nationwide Readmissions Database, we analyzed nonelective adult CS admissions at MCS- and CCL-capable hospitals. Hospitals were stratified into quartiles by annual volumes of MCS (intra-aortic balloon pump, percutaneous ventricular assist device, extracorporeal membrane oxygenation) and CCL procedures (coronary angiography, percutaneous coronary intervention), with the top quartile classified as high-volume (HVH-MCS or HVHCCL). Multivariable logistic and linear regression models were constructed to evaluate the independent association of high-volume status with mortality, complications, and resource utilization. Among 130,822 CS hospitalizations, 48.2% were treated at HVH-MCS and 46.1% at HVHCCL. Unadjusted mortality was lower at HVH-MCS (24.8% vs 30.7%, p <0.001) and HVHCCL (26.6% vs 29.0%, p <0.001). Following adjustment, HVH-MCS remained associated with reduced mortality (Adjusted odds ratio [AOR] 0.87, 95% confidence interval [CI] 0.82 to 0.93), while HVHCCL showed no significant benefit (p = 0.10). HVH-MCS also had lower respiratory (AOR 0.82, 95% CI 0.78 to 0.86) and infectious (AOR 0.85, 95% CI 0.80 to 0.90) complications, but longer hospital stays (β +1.75 days, 95% CI 1.48 to 2.01) and higher costs (+$8,600, 95% CI 7,100 to 10,100). Increasing MCS volume appears independently correlated with improved CS outcomes, highlighting the cross-volume effect of institutional expertise. Contrastingly, CCL volume was not associated with in-hospital mortality, supporting centralization of CS care at high-volume MCS centers.
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Tabibian et al. (2025) conducted an observational in Cardiogenic Shock (n=130,822). Treatment at high-volume mechanical circulatory support (HVH-MCS) hospitals vs. Treatment at lower-volume hospitals was evaluated on In-hospital mortality (AOR 0.87, 95% CI 0.82-0.93, p=<0.001). Admission to high-volume mechanical circulatory support centers was associated with reduced mortality for cardiogenic shock compared to lower-volume centers (AOR 0.87; 95% CI 0.82-0.93).
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