Single Acute Mechanical Circulatory Support Device Use is Associated with Reduced Mortality Compared to Multi-Agent Drug Therapy Alone for Cardiogenic Shock: An Analysis of the Cardiogenic Shock Working Group Registry

Abstract

<h3>Purpose</h3> Real world evidence evaluating outcomes in cardiogenic shock complicating heart failure or ST-segment elevation myocardial infarction (HF-CS and STEMI-CS) in the contemporary era of acute mechanical circulatory support (AMCS) remains a major unmet need. We studied the utility of the recently proposed Society for Cardiovascular Angiography and Interventions (SCAI) stages in HF- and STEMI-CS. <h3>Methods</h3> The Cardiogenic Shock Working Group registry includes CS patients from 15 US hospitals enrolled between 2016-2021. Patients were classified by the maximum SCAI stage (B-E) reached during hospitalization based on drug (vasopressors or inotropes) and device use. In-hospital mortality was evaluated for association with SCAI stages. <h3>Results</h3> Of the 3171 patients with CS, 1680 (53%) and 739 (23%) were due to HF or STEMI. In-hospital mortality was 24% vs 42% (p<0.01) for HF or STEMI CS respectively. In-hospital mortality was associated with increasing SCAI stage among patients with HF-CS (Odds Ratio [95% CI], 3.129 [2.59-3.78], p<0.001) or STEMI-CS (Odds Ratio [95% CI], 2.158 [1.78-2.62], p<0.001; Fig A-D). Compared to patients receiving ≥3 drugs and no AMCS device, in-hospital mortality was lower among HF-CS patients receiving 1 AMCS device with ≤2 drugs (Fig E) and lower among STEMI-CS patients receiving 1 AMCS device irrespective of concomitant drug use (Fig F). <h3>Conclusion</h3> Using one of the largest, contemporary, multi-center, real-world practice registries of CS, our findings support a direct association between SCAI stages and in-hospital mortality in HF-CS and STEMI-CS and further identify that compared to multi-agent drug therapy alone, single AMCS device use may be associated with lower mortality. These findings support the need for randomized clinical trials in HF- and STEMI-CS.