• Acute coronary syndromes
• Atherosclerosis
• C-reactive protein
• Cardiogenic shock
• Gender medicine
• Inflammation
• LVEF
• Machine learning
• Multilayer perceptron
• Percutaneous coronary intervention
• Personalized risk prediction
• Precision medicine
• Random forest

• Humans
• Shock, Cardiogenic/mortality
• Shock, Cardiogenic/etiology
• Shock, Cardiogenic/therapy
• Acute Coronary Syndrome/complications
• Male
• Female
• Aged
• Sex Factors
• Middle Aged
• Percutaneous Coronary Intervention
• Risk Assessment/methods
• Hospital Mortality
• Risk Factors

• 33CM30-124112 Swiss National Research Foundation
• Novartis Foundation for Medical-Biological Research
• Swiss Heart Foundation
• Research Prize of the Swiss Society of Cardiology
• Jubiläumsstiftung SwissLife
• Foundation for Cardiovascular Research - Zurich Heart House
• China Scholarship Council
• Foundation for Cardiovascular Research – Zurich Heart House

• MIMIC-IV
• acute myocardial infarction
• cardiogenic shock
• eICU-CRD
• hospital mortality
• machine learning

• acute heart failure
• cardiogenic shock
• hemodynamics
• left heart failure
• pressure-volume loop
• right heart failure

• Diastolic arterial pressure
• Mean arterial pressure
• Microcirculation
• Perfusion
• Septic shock

• Humans
• Shock/physiopathology
• Arterial Pressure
• Critical Care

• acute myocardial infarction
• cardiogenic shock
• clinical outcomes
• mechanical circulatory support
• mortality risk factors

• Acute myocardial infarction
• Cardiogenic shock
• Mortality
• Predictors
• Primary percutaneous coronary intervention

• cardiogenic
• inotrope
• mechanical circulatory support
• shock
• vasopressor

• Humans
• Shock, Cardiogenic/drug therapy
• Vasoconstrictor Agents/therapeutic use
• Vasoconstrictor Agents/pharmacology
• Hemodynamics
• Vascular Resistance
• Perfusion

• National Heart Foundation of Australia
• National Health and Medical Research Council

• CICU
• SCAI shock
• cardiogenic shock
• machine learning
• mortality
• risk score

• Adult
• Humans
• Middle Aged
• Shock, Cardiogenic/diagnosis
• Shock, Cardiogenic/therapy
• Retrospective Studies
• Intensive Care Units
• Risk Factors
• Hospital Mortality

• T32 GM007753 NIGMS NIH HHS
• T32 GM144273 NIGMS NIH HHS
• U54 HG012510 NHGRI NIH HHS

• Body mass index
• Cardiogenic shock
• Obesity
• Shock team

• acute myocardial infarction
• cardiogenic shock
• laboratory biomarkers
• outcomes

• NV19-02-00086 Ministry of Health of the Czech Republic

• Cardiogenic shock
• IABP
• acute myocardial infarction
• prognosis
• shock index

Latin America has limited information about the full spectrum cardiogenic shock (CS) and its hospital outcome. This study sought to examine the temporal trends, clinical features and outcomes of patients with CS in a coronary care unit of single Mexican institution.

This was a retrospective study of consecutive patients hospitalized with CS in a Mexican teaching hospital between 2006–2019. Patients were classified according to the presence or absence of acute myocardial infarction (AMI).

Of 22,747 admissions, 833 (3.7%) exhibited CS. Among patients with AMI (n = 12,438), 5% had AMI–CS, and in patients without AMI (n = 10,309), 2.3% developed CS (non-AMI–CS). Their median age was 63 years and 70.5% were men. Cardiovascular risk factors were more frequent among the AMI–CS group, whereas a history of heart failure was greater in non-AMI–CS patients (70.1%). In AMI-CS patients, the median delay time was 17.2 hours from the onset of AMI symptoms to hospital admission. Overall, the median left ventricular ejection fraction (LVEF) was 30%. Patients with CS at admission showed end-organ dysfunction, evidenced by lactic acidosis, renal impairment, and elevated liver transaminases. Of the 620 AMI–CS patients, the main cause was left ventricular dysfunction in 71.3%, mechanical complications in 15.2% and right ventricular infarction in 13.5%. Among the 213 non-AMI–CS patients, valvular heart disease (49.3%) and cardiomyopathies (42.3%) were the most frequent etiologies. In-hospital all-cause mortality rates were 69.7% and 72.3% in the AMI–CS and non-AMI–CS groups, respectively. Among AMI–CS patients, renal dysfunction, diabetes, older age, depressed LVEF, absence of revascularization and the use of mechanical ventilation were independent predictors of in-hospital mortality. However, in the non-AMI–CS group, only low LVEF and high lactate levels proved significant.

This study demonstrates differences in the epidemiology of CS compared to high-income countries; the high mortality reflects critically ill patients and the lack of contemporary effective therapies in the population studied.

• Acute Heart Failure
• Acute myocardial infarction
• Cardiogenic shock
• Cardiogenic shock without AMI
• Latin America
• Middle-income countries

• Cardiogenic shock
• acute myocardial infarction
• mechanical circulatory support
• risk score

Purpose: To determine whether inotrope administration is associated with increased all-cause mortality in cardiogenic shock (CS) patients and to identify inotropes superior for improving mortality.

Methods: This retrospective cohort study analyzed data retrieved from the Philips Electronic ICU (eICU) database, a clinical database of 200,859 patients from over 208 hospitals located throughout the United States. The database was searched for patients admitted with CS to the intensive care unit (ICU) between 2014 and 2015. We evaluated 34,381 CS patients. They were classified into the inotrope and non-inotrope groups based on whether inotropes were administered during hospitalization. The primary endpoint was all-cause hospital mortality.

Findings: In total, 15,021 (43.69%) patients received inotropes during hospitalization. The in-hospital mortality rate was significantly higher in the inotrope group than in the non-inotrope group (2,999 [24.03%] vs. 1,547 [12.40%], adjusted hazard ratio: 2.24; 95% confidence interval [CI]: 2.09–2.39; p < 0.0001). After propensity score matching according to the cardiac index, 359 patients were included in each group. The risk of ICU (OR 5.65, 95% CI, 3.17–10.08, p < 0.001) and hospital (OR 2.63, 95% CI: 1.75–3.95, p < 0.001) mortality in the inotrope group was significantly higher. In the inotrope group, the administration of norepinephrine ≤0.1 μg/kg/min and dopamine ≤15 μg/kg/min did not increase the risk of hospital mortality, and milrinone administration was associated with a lower mortality risk (odds ratio: 0.559, 95% CI: 0.430–0.727, p < 0.001). Meanwhile, the administration of >0.1 μg/kg/min dobutamine, epinephrine, and norepinephrine and dopamine >15 μg/kg/min was associated with a higher risk of hospital mortality.

Conclusions: Inotropes should be used cautiously because they may be associated with a higher risk of mortality in CS patients. Low-dose norepinephrine and milrinone may associated with lower risk of hospital mortality in these patients, and supportive therapies should be considered when high-dose inotropes are administered.

• cardiogenic shock
• inotrope
• intensive care unit
• mortality
• outcome

• ECMO/IABP/Tandem/Impella
• STEMI
• acute myocardial infarction
• cardiogenic shock
• mechanical circulatory support

Supplemental Digital Content is available in the text.

With percutaneous left ventricular mechanical circulatory support devices becoming increasingly available for patients with cardiogenic shock due to acute myocardial infarction and the lack of a clear mortality benefit to date, identifying optimal candidates for this technology is crucial. We studied the effectiveness of Impella Cardiac Pow (Abiomed, Danvers, MA) in various stages of cardiogenic shock and elderly cohorts.

Retrospective review.

Data were collected for patients at a single community hospital between January 1, 2018, and December 31, 2019.

Thirty-one consecutive adult patients with cardiogenic shock due to acute myocardial infarction who received Impella Cardiac Pow support. Shock stages were defined by the Society for Cardiovascular Angiography and Intervention (Stages A–E).

None.

The primary outcome was in-hospital death across Society for Cardiovascular Angiography and Intervention cardiogenic shock stages and in patients greater than or equal to 80 and less than 80 years old. Secondary outcomes were Valve Academic Research Consortium-2 vascular and bleeding complications, stroke, and renal failure requiring dialysis. The median age of the study population was 64 years, with seven patients (23%) being greater than or equal to 80 years old. No patients were in Society for Cardiovascular Angiography and Intervention Stage A, whereas there were seven in B, eight in C, six in D, and 10 (32%) in E. Overall in-hospital mortality occurred in 61% of patients. All 10 patients in Stage E died before hospital discharge. Mortality occurred in 54% of patients (13/24) age less than 80 years compared with 86% of those 80 years or older (6/7). A total of 38.7% of patients (12/31) and 32.3% of patients (10/31) experienced Valve Academic Research Consortium-2 bleeding and vascular events, which were evenly distributed across Society for Cardiovascular Angiography and Intervention cardiogenic shock Stages.

In conclusion, patients with shock in extremis and those 80 years old and older may have a prohibitively high mortality despite Impella use. These findings merit further prospective investigation in a larger number of patients to evaluate the effectiveness of Impella (and other left ventricular mechanical circulatory devices) and the inherent resource utilization in advanced cardiogenic shock and the elderly.

• Impella
• Society for Cardiovascular Angiography and Intervention
• age
• cardiogenic shock
• mechanical support
• myocardial infarction

• ST-elevation myocardial infarction
• cardiogenic shock
• long-term mortality
• primary percutaneous coronary intervention
• risk score

• cardiogenic shock
• cardiovascular disease
• dopamine
• norepinephrine
• vasopressor agents

• acute coronary syndrome
• all-cause mortality
• cardiovascular mortality
• j-curve
• older
• sbp

• Acute Coronary Syndrome/complications
• Aged
• Cohort Studies
• Female
• Hospitalization
• Humans
• Retrospective Studies
• Risk
• Risk Factors

Here, we review the importance of using hemodynamic data to guide therapy and risk stratification in cardiogenic shock as well as the various definitions of this syndrome that have been used in prior studies. Furthermore, we provide perspective regarding the controversy surrounding pulmonary artery (PA) catheter use as well as current society guidelines and scientific statements. Lastly, we review the technical aspects for accurate interpretation of data of cardiogenic shock.

More recent studies specifically evaluating cardiogenic shock patients have shown higher mortality when PA catheters were not used. Furthermore, initiatives are underway to develop more standardized definitions of cardiogenic shock, including the SCAI Shock Classification Scheme. Only by having a standardized fashion of conveying severity of shock will we be able to more systematically study this patient population and improve outcomes moving forward.

PA catheters are critical to the prognostication and management of a subset of patients with cardiopulmonary disease, particularly in those with pulmonary hypertension, cardiogenic shock, or requiring mechanical circulatory support or undergoing evaluation for advanced heart failure therapies.

• Cardiogenic shock
• Hemodynamic monitoring
• Pulmonary artery catheters

• Age
• Cardiogenic shock
• Frailty
• Shock
• Survival

• Age
• Cardiac intensive care unit
• Cardiogenic shock
• Critical care
• Mortality
• Outcomes
• Shock

• Blood flow
• Coronary blood flow
• Mean pressure
• Resistance
• Vascular compliance
• Volume

• erythrocyte indices
• intensive care units
• mortality
• shock, cardiogenic

• Aged
• Critical Illness/mortality
• Erythrocyte Indices
• Female
• Humans
• Male
• Shock, Cardiogenic/blood
• Shock, Cardiogenic/mortality

• STEMI
• cardiogenic shock
• reperfusion
• risk stratification
• thrombolytic therapy

• blood pressure
• hospitalization
• myocardial infarction

• Acute Coronary Syndrome/physiopathology
• Acute Disease
• Blood Pressure/physiology
• Blood Pressure Determination/methods
• Cardiovascular Diseases/epidemiology
• Hospitalization/trends
• Humans
• Hypertension/complications
• Hypertension/epidemiology
• Hypertension/physiopathology
• Myocardial Infarction/epidemiology
• Myocardial Infarction/etiology
• Prevalence
• Prognosis
• Risk Factors

• cardiogenic shock
• risk stratification
• inotropes
• circulatory support

• Humans
• Patient Care Management/methods
• Patient Care Management/organization & administration
• Shock, Cardiogenic/therapy
• Triage

• T32 HL069749 NHLBI NIH HHS
• U54 GM115428 NIGMS NIH HHS

• Cardiogenic shock
• Choc cardiogénique
• Mortality
• Mortalité
• Prognosis
• Pronostic

• Cardiogenic shock
• Hemodynamic
• Hypoperfusion
• Pressure-volume loops
• Right heart catheterization

• Hemodynamics/physiology
• Humans
• Monitoring, Physiologic/methods
• Multimodal Imaging/methods
• Shock, Cardiogenic/diagnosis
• Shock, Cardiogenic/physiopathology

Mechanical circulatory support devices are being used to an increasing extent. The use of these devices as an adjunct to cardiac surgery to support ventricular function has contributed to improved outcomes for the highest risk patients. In the context of patients undergoing coronary artery bypass grafting, there are several potential indications for mechanical circulatory support: preoperatively in the setting of acute cardiogenic shock, or in patients with intractable angina with or without haemodynamic compromise; at induction of anaesthesia prophylactically in patients with critical coronary anatomy and/or severely impaired left ventricular function; intraoperatively in the setting of failure to wean from cardiopulmonary bypass; or postoperatively in patients who develop an intractable low cardiac output state. The use of the intra-aortic balloon pump, veno-arterial extracorporeal membrane oxygenation, TandemHeart, Impella and central ventricular assist devices will be considered in the setting of high-risk patients undergoing coronary artery bypass grafting.

• ECMO
• Intra-aortic balloon pump
• Mechanical circulatory support

Myocardial infarction (MI) complicated by cardiogenic shock (MI-CS) is a major cause of cardiovascular morbidity and mortality. Predictors of outcomes in MI-CS include clinical, laboratory, radiologic variables, and management strategies. This article reviews the existing literature on short- and long-term predictors and risk stratification in MI complicated by CS.

• AHA Scientific Statements
• delivery of health care
• disease management
• shock, cardiogenic

• American Heart Association
• Delivery of Health Care, Integrated/organization & administration
• Health Care Costs
• Hemodynamics
• Humans
• Patient Selection
• Phenotype
• Predictive Value of Tests
• Regional Health Planning/organization & administration
• Risk Factors
• Shock, Cardiogenic/diagnosis
• Shock, Cardiogenic/epidemiology
• Shock, Cardiogenic/physiopathology
• Shock, Cardiogenic/therapy
• Treatment Outcome
• United States

• Cardiogenic shock
• Coronary artery disease
• Multivessel revascularization
• Percutaneous coronary intervention
• Revascularization