Aims/Background:
Cardiogenic shock, as a complication of various cardiovascular diseases, remains a condition with high mortality rates despite advances in diagnosis and treatment. Accurate prediction of a patient’s expected mortality can help to ensure that invasive treatments—which are therefore associated with a risk of complications, such as mechanical circulatory support—are appropriately reserved for those patients who are likely to benefit from them, whilst also providing a basis for decisions such as de- escalating treatment.
The DANGER-Shock trial has shown that the survival benefit for patients treated with a microaxial flow pump was not immediately apparent in the first 30 days, but only became statistically significant over time. Existing risk prediction tools for cardiogenic shock have focused in particular on short-term mortality, for example in the first 30 days following the index event, whereas long-term outcome might be a better parameter for defining treatment goals.
Methods:
We therefore conducted a retrospective analysis of a database already established at our centre, which includes 152 patients with cardiogenic shock, to investigate factors associated with an increased risk of death at 30 and 180 days, and to analyse parameters that are particularly suitable for predicting 180-day mortality.
Results:
This study shows, amongst other things, that a higher SCAI stage (D/E vs. B/C) is associated with a significantly higher 30-day mortality rate, but not with a higher 180- day mortality rate (HR 4.61 (CI 2.43, 8.75), p < 0.0001 vs. HR 2.3 (CI 0.81, 6.52), p 0.12). LVEF is not associated with a significantly increased mortality rate at 30 or 180 days (HR 0.98 (CI 0.95, 1.01), p = 0.2 vs. HR 1.01 (CI 0.96, 1.06), p = 0.7), whereas TAPSE, as a marker of right ventricular function, is associated with increased 30-day but not 180-day mortality (HR 0.91 (CI 0.84, 1), p 0.039 vs. HR 0.97 (CI 0.86, 1.09), p 0.61). Elevated lactate levels, as a marker of reduced tissue perfusion, correlate significantly with 30- day mortality but not with 180-day mortality (HR 1.16 (CI 1.08, 1.24), p < 0.0001 vs. HR 1.09 (CI 0.95, 1.24), p 0.22). Pro-adrenomedullin (Pro-ADM) is a new and interesting parameter in cardiogenic shock. Elevated pro-ADM levels showed the strongest association with increased 180-day mortality, whereas 30-day mortality was not significantly associated with elevated pro-ADM levels (HR 1.51 (CI 0.94, 2.43), p 0.086 vs. HR 5.48 (CI 2.39, 12.55), p <0.0001).
