Baseline characteristics, management, and predictors of early mortality in cardiogenic shock: insights from the FRENSHOCK registry

Abstract

Aims Published data on cardiogenic shock (CS) are scarce and are mostly focused on small registries of selected populations. The aim of this study was to examine the current CS picture and define the independent correlates of 30 day mortality in a large non‐selected cohort. Methods and results FRENSHOCK is a prospective multicentre observational survey conducted in metropolitan French intensive care units and intensive cardiac care units between April and October 2016. There were 772 patients enrolled (mean age 65.7 ± 14.9 years; 71.5% male). Of these patients, 280 (36.3%) had ischaemic CS. Organ replacement therapies (respiratory support, circulatory support or renal replacement therapy) were used in 58.3% of patients. Mortality at 30 days was 26.0% in the overall population (16.7% to 48.0% depending on the main cause and first place of admission). Multivariate analysis showed that six independent factors were associated with a higher 30 day mortality: age [per year, odds ratio (OR) 1.06, 95% confidence interval (CI): 1.04–1.08], diuretics (OR 1.74, 95% CI: 1.05–2.88), circulatory support (OR 1.92, 95% CI: 1.12–3.29), left ventricular ejection fraction <30% (OR 2.15, 95% CI: 1.40–3.29), norepinephrine (OR 2.55, 95% CI: 1.69–3.84), and renal replacement therapy (OR 2.72, 95% CI: 1.65–4‐49). Conclusions Non‐ischaemic CS accounted for more than 60% of all cases of CS. CS is still associated with significant but variable short‐term mortality according to the cause and first place of admission, despite frequent use of haemodynamic support, and organ replacement therapies.

Cardiogenic shock among cancer patients

“…In this registry, 30-day mortality was 29.4% in CPs. Interestingly, in this study, cancer was not an independent variable associated with 30-day mortality (14).…”

Enrolling patients in cardiogenic shock trials: are we missing someone? Insights from the Italian AltShock‐2 registry

“…A subanalysis on 219 patients evaluated survival on the basis of the capacity to express consent at the time of study entry: mortality was 78.5% in those who were unable to consent (36% of the population), as compared to 30.5% in the competent patients. This is further confirmed by the recently published French Cardiogenic shock registry in which enrolment was not allowed for patients who were unable to consent: indeed, 30‐day mortality was 26%, impressively lower than other large international registries, confirming that ability to consent is a marker of better baseline conditions and a predictor of less fatal outcome 2 …”

“…This is further confirmed by the recently published French Cardiogenic shock registry in which enrolment was not allowed for patients who were unable to consent: indeed, 30-day mortality was 26%, impressively lower than other large international registries, confirming that ability to consent is a marker of better baseline conditions and a predictor of less fatal outcome. 2 This complexity can be captured by the enrolment of Society for Cardiovascular Angiography and Interventions stage D-E patients who are, by definition, unable to consent. However, entry data in terms of SCAI classification are heterogeneous; if we look at registries from different areas of the world, the use of mechanical circulatory support (MCS) (especially biventricular support with veno-arterial extracorporeal membrane oxygenation) is not reproducible across the sickest class of patients and might result not only into a different capacity to enrol patients when informed consent is required, but also in a macroscopic signal of failure of classification (Table 2).…”

“…However, entry data in terms of SCAI classification are heterogeneous; if we look at registries from different areas of the world, the use of mechanical circulatory support (MCS) (especially biventricular support with veno-arterial extracorporeal membrane oxygenation) is not reproducible across the sickest class of patients and might result not only into a different capacity to enrol patients when informed consent is required, but also in a macroscopic signal of failure of classification (Table 2). [2][3][4][5][6] On this basis, we might argue that the real-world mortality of cardiogenic shock is even higher as compared to what has been commonly reported. Indeed, the possibility of null results of ongoing RCTs in terms of survival should be considered, and other endpoints could be considered (combined/composite endpoints, clinical stabilization, utilization of resources to survival).…”

Evolving Presentation of Cardiogenic Shock: A Review of the Medical Literature and Current Practices

“…Of note, the use of norepinephrine as first-line therapy in heart failure is controversial because of the generally counterproductive increase in heart rate and SVR [ 15 ]. The FRENSHOCK (FREnch observatory on the management of cardiogenic SHOCK) registry, in which over 60% of cases were nonischemic in etiology, norepinephrine use was one of six independent risk factors for 30-day mortality identified by multivariate analysis (OR 2.55, 95% CI 1.69–3.84) [ 26 ] (Table 1 ). In the DOREMI (DObutamine compaREd with MIlrinone) trial, a single-center, double-blind study of 192 patients randomized to either milrinone or dobutamine, there were no significant differences in major adverse cardiovascular events or need for renal replacement therapy (RRT) between the groups [ 23 ].…”