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Observational Study
. 2025 Apr;27(4):659-668.
doi: 10.1002/ejhf.3627. Epub 2025 Feb 16.

Organ perfusion pressure predicts outcomes in cardiogenic shock patients

Pier Paolo Bocchino  1 , Simone Frea  1 , Alice Sacco  2 , Maurizio Bertaina  3 , Federico Pappalardo  4 , Guido Tavazzi  5   6 , Nuccia Morici  7 , Filippo Angelini  1 , Laura Garatti  2 , Martina Briani  8 , Carlotta Sorini Dini  9 , Luca Villanova  2 , Guglielmo Gallone  1 , Amelia Ravera  10 , Letizia Bertoldi  8 , Anna Corsini  11 , Giulia Maj  12 , Luciano Potena  11 , Rita Camporotondo  13 , Costanza Natalia Julia Colombo  13 , Andrea Montisci  14 , Fabrizio Oliva  2 , Mario Iannaccone  3 , Nicoletta D'Ettore  12 , Serafina Valente  9 , Matteo Pagnesi  15 , Marco Metra  15 , Marco Marini  16 , Gaetano Maria De Ferrari  1   17
Affiliations
Observational Study

Organ perfusion pressure predicts outcomes in cardiogenic shock patients

Pier Paolo Bocchino et al. Eur J Heart Fail. 2025 Apr.

Abstract

Aims: The diagnosis of cardiogenic shock (CS) relies upon signs and/or symptoms of end-organ hypoperfusion. The combination of hypoperfusion and systemic congestion identifies patients at particularly high risk. This study evaluated organ perfusion pressure (OPP), calculated as mean arterial pressure minus invasive central venous pressure, as a predictor of outcomes in CS.

Methods and results: All consecutive patients with acute myocardial infarction-related CS (AMI-CS) or acutely decompensated heart failure-related CS (ADHF-CS) enrolled in the multicentre Altshock-2 registry between January 2020 and November 2023 were included. The primary outcome was in-hospital all-cause mortality. Overall, 316 patients were included (mean age: 64 ± 13 years, 62 [20%] female, median left ventricular ejection fraction: 22% [interquartile range, IQR 15-30%], 261 [85.9%] SCAI stage C or worse, median OPP at presentation: 57.0 mmHg [IQR 47.0-69.8 mmHg]). A total of 117 (37%) patients died during the hospitalization. Low OPP (i.e. <57.0 mmHg) was associated with significantly higher in-hospital all-cause mortality (hazard ratio [HR] 1.757, 95% confidence interval [CI] 1.208-2.556, p = 0.003), whereas low mean arterial pressure alone was not (HR 1.323, 95% CI 0.901-1.941, p = 0.153). After multivariable adjustment for significant clinical data available at first bedside assessment (age and Sequential Organ Failure Assessment score), low OPP still predicted significantly higher in-hospital all-cause mortality (HR per mmHg decrease: 1.016, 95% CI 1.004-1.029, p = 0.010). Low OPP appeared particularly powerful in predicting higher in-hospital all-cause mortality among ADHF-CS patients (HR 3.172, p = 0.002).

Conclusion: In this multicentre, observational, prospective study on patients hospitalized for CS, lower OPP on admission was associated with significantly higher in-hospital all-cause mortality.

Keywords: Acute heart failure; Blood pressure; Cardiogenic shock; Central venous pressure; Organ perfusion pressure.

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References

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