Cardiogenic Shock Mortality According to Aetiology in a Mediterranean Cohort: Results From the Shock-Cat Study

Abstract

Background and objectivesMortality 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.MethodsShock-CAT study was a multicentre, prospective, observational study conducted from December 2018-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-days mortality risk were also compared.ResultsA 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 (OR 2.24, p=0.019). The IABP-SHOCK II had superior discrimination for predicting 90-days mortality when compared with CardShock in AMI-CS patients (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).ConclusionsIn our cohort, AMI-CS mortality was increased by two-fold when compared to non- AMI-CS. IABP-SHOCK II score provides better 90-days mortality risk prediction than CardShock score in AMI-CS, but both scores performed similar in non-AMI-CS patients.