Related Experiment Video
Updated: Jun 6, 2025
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Cardiogenic shock mortality according to Aetiology in a Mediterranean cohort: Results from the Shock-CAT study
Cosme García-García1,2,3, Teresa López-Sobrino4,5, Esther Sanz-Girgas6
1Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.
Insights
Mortality in cardiogenic shock (CS) is higher for patients with acute myocardial infarction (AMI-CS) compared to non-AMI-CS. The IABP-SHOCK II score better predicts 90-day mortality in AMI-CS patients than the CardShock score.
Area of Science:
- Cardiology
- Critical Care Medicine
- Clinical Research
Background:
- Mortality in cardiogenic shock (CS) remains high, influenced by underlying causes.
- Effective risk stratification is crucial for managing CS patients.
- Aetiology-specific prognosis and validated scoring systems are needed.
Purpose of the Study:
- To investigate in-hospital prognosis and mortality in CS patients based on aetiology.
- To compare the prognostic accuracy of the CardShock and IABP-SHOCK II scores for 90-day mortality risk.
Main Methods:
- Prospective, observational, multicentre study (Shock-CAT) of 382 consecutive CS patients.
- Comparison of outcomes between acute myocardial infarction (AMI)-CS and non-AMI-CS.
- Evaluation of CardShock and IABP-SHOCK II score accuracy for 90-day mortality.
Main Results:
- AMI-CS patients (60.7%) had higher in-hospital mortality (37.1% vs. 26.7%) and a two-fold increased risk compared to non-AMI-CS.
- AMI-CS patients required more mechanical circulatory support (MCS).
- IABP-SHOCK II score demonstrated superior discrimination for 90-day mortality in AMI-CS (AUC 0.74 vs. 0.66), while scores performed similarly in non-AMI-CS.
Conclusions:
- Acute myocardial infarction-related cardiogenic shock carries a significantly increased mortality risk.
- The IABP-SHOCK II score offers improved 90-day mortality prediction in AMI-CS patients.
- Prognostic score performance varies between CS aetiologies.
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.
