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.