Clinical characteristics, management, and predictors of mortality: results from the national prospective cardiogenic shock registry (CZECH-SHOCK)

Abstract

Aims: Only limited epidemiological data exist from national or international prospective multicentre registries covering the whole spectrum of cardiogenic shock (CS) aetiologies.

Methods and results: A national prospective multicentre observational study, CZECH-SHOCK, was conducted in 15 main tertiary care centres in Czechia over a 12 month period from March 2023 to February 2024. A total of 418 patients with a median age of 70 (interquartile range 59-76) years were enrolled. The majority of patients was males (69.6%). A newly developed heart failure was observed in 76.8% patients, and acute myocardial infarction complicated by CS was the most frequent cause of a CS episode (56.7%). Mechanical circulatory support devices were utilized in 28.2% of cases. A 30 day mortality was 39.5%. In a multivariate analysis, six independent factors were associated with a higher 30 day mortality: age [odds ratio (OR) per 10-year increase: 1.78, 95% confidence interval (CI): 1.45-2.19], history of coronary artery disease (OR: 2.38, 95% CI: 1.41-4.30), history of chronic obstructive pulmonary disease (OR: 2.58, 95% CI: 1.27-5.25), Society for Cardiovascular Angiography and Interventions class on admission (OR per one class increase: 1.64, 95% CI: 1.27-2.11), renal replacement therapy during in-hospital stay (OR: 2.46, 95% CI: 1.32-4.59), and new mechanical ventilation after admission (OR: 4.58, 95% CI: 2.50-8.39).

Conclusion: Acute myocardial infarction complicated by CS still represents the most frequent cause of CS episodes. The in-hospital mortality of patients with CS remains high, despite frequent utilization of haemodynamic support and organ replacement therapies.

Keywords: AMI-CS; CZECH-SHOCK; Cardiogenic shock; Mortality; Shock registry.