Cardiogenic shock mortality according to Aetiology in a Mediterranean cohort: Results from the Shock‐CAT study

Abstract

Aims

Mortality in cardiogenic shock (CS) remains elevated, with the potential for CS causes to impact prognosis and risk stratification. The aim was to investigate in‐hospital prognosis and mortality in CS patients according to aetiology. We also assessed the prognostic accuracy of CardShock and IABP‐SHOCK II scores.

Methods

Shock‐CAT study was a multicentre, prospective, observational study conducted from December 2018 to November 2019 in eight university hospitals in Catalonia, including non‐selected consecutive CS patients. Data on clinical presentation, management, including mechanical circulatory support (MCS) were analysed comparing acute myocardial infarction (AMI) related CS and non‐AMI‐CS. The accuracy of CardShock and IABP‐SHOCK II scores to assess 90 day mortality risk were also compared.

Results

A total of 382 CS patients were included, age 65.3 (SD 13.9) years, 75.1% men. Patients were classified as AMI‐CS (n = 232, 60.7%) and non‐AMI‐CS (n = 150, 39.3%). In the AMI‐CS group, 77.6% were STEMI. Main aetiologies for non‐AMI‐CS were heart failure (36.2%), arrhythmias (22.1%) and valve disease (8.0%). AMI‐CS patients required more MCS than non‐AMI‐CS (43.1% vs. 16.7%, P < 0.001). In‐hospital mortality was higher in AMI‐CS (37.1 vs. 26.7%, P = 0.035), with a two‐fold increased risk after multivariate adjustment (odds ratio 2.24, P = 0.019). The IABP‐SHOCK II had superior discrimination for predicting 90 day mortality when compared with CardShock in AMI‐CS patients [area under the curve (AUC) 0.74 vs. 0.66, P = 0.047] although both scores performed similarly in non‐AMI‐CS (AUC 0.64 vs. 0.62, P = 0.693).

Conclusions

In our cohort, AMI‐CS mortality was increased by two‐fold when compared with non‐AMI‐CS. IABP‐SHOCK II score provides better 90 day mortality risk prediction than CardShock score in AMI‐CS, but both scores performed similar in non‐AMI‐CS patients.