Identifying biomarker-driven subphenotypes of cardiogenic shock: analysis of prospective cohorts and randomized controlled trials.

Background The current Society for Cardiovascular Angiography and Interventions (SCAI) shock stage classification does not include the systemic inflammatory response to risk stratify patients with cardiogenic shock. Purpose To evaluate the prognostic impact of the inflammatory response, on top of the SCAI shock classification, during cardiogenic shock using C-Reactive protein (CRP). Methods We analyzed CRP levels and SCAI shock classification in consecutive patients admitted for cardiogenic shock between January 2010 and December 2020, included in the ACTION-SHOCK registry of our tertiary center. Patients with ongoing sepsis or other extracardiac causes for elevated CRP were excluded. Using logistic regression method, we assessed both the association between CRP levels at admission and all-cause mortality at 90 days, and the value of the addition of baseline CRP level to SCAI stage of shock for the prediction of 90-day mortality. Results Among 755 patients admitted with cardiogenic shock (median age 61 years, interquartile range [IQR] 50-72, 27% of female), only 128 (17%) had normal values of CRP (< 5mg/L) at admission. Median CRP at admission was 19mg/l (IQR 6-55). There was an association between 90-day mortality and baseline CRP (Odds Ratio [OR] = 1.02, 95% Confidence Interval [95%CI] 1.01-1.03 per 5mg/L of CRP, p=0.004), still significant after adjustment on clinical and biological variables associated with 90-day mortality in univariate analysis, including the SCAI shock stage (adjusted OR 1.02, 95%CI 1.01 - 1.03 per 5 mg/L, p=0.042). The addition of CRP increased the accuracy of the SCAI shock stages for the prediction of 90-day mortality (Area under the Curve increased from 0.59, 95% CI 0.50 - 0.66 to 0.65, 95% CI 0.61 - 0.72). Interestingly, the association of CRP with mortality was driven by patients in SCAI shock classes A and B (figure). Conclusions CRP elevation was frequently observed in this population of patients with any cause of cardiogenic shock and was associated with 90-day mortality. This was particularly evident for patients in lower SCAI shock stages on admission.Figure 1

BackgroundCardiogenic shock (CS) is characterized by high mortality and requires accurate prognostic tools to predict outcomes and guide treatment. The Society for Cardiovascular Angiography and Interventions (SCAI) shock classification indicates shock severity and can be used for outcome prediction. ObjectiveHere, we compare the prognostic performance of SCAI shock classification determined on admission and during intensive care unit (ICU) stay. MethodsWe included all patients with CS or conditions associated with developing CS based on ICD codes. SCAI shock stages were determined on admission and during the first 5 days of ICU stay. Receiver operating curves were used to compare the prognostic performance of SCAI stages on admission, SCAI stages during ICU stay and CS evolution (absent, resolved, persistent and new onset) for in-hospital mortality. ResultsBetween 01/2018 and 06/2022, 1303 patients were identified and 862 patients were included. On admission, 50.6 % patients had SCAI shock stage A, 3.9 % SCAI shock stage B, 17.7 % SCAI shock stage C, 7.0 % SCAI shock stage D and 20.8 % SCAI shock stage E. Shock stage distribution changed dynamically during ICU stay. Compared to SCAI stage on admission (AUC 0.80; 95 % CI 0.77–0.83), highest achieved SCAI stage during ICU (AUC 0.86, 95 % CI 0.83–0.89, p < 0.0001) and shock evolution (AUC 0.87, 95 % CI 0.85–0.90, p < 0.0001) yielded better prognostic performance. ConclusionsSCAI shock stages changed dynamically during ICU stay, and prognostic performance can be improved by considering highest achieved SCAI shock stage as well as the evolution of CS compared to SCAI shock stage on admission.

Funding Acknowledgements Type of funding sources: None. Background Mortality from cardiogenic shock (CS) shows great disparities (1). This evidence reflects variations in access to care and medical practice, related to the lack of clear guidelines for appropriate patient selection for mechanical circulatory support (MCS) application. In this regard, the results of most trials or meta-analyses were neutral on survival, and the costs in terms of patient morbidity/mortality are high and unproven (2). Accordingly, a judicious use of MCS is crucial for an adequate resource allocation and to avoid futility. Purpose To characterize trends in use of support devices and compare outcomes between CS patients included in a contemporary national Cardiac Intensive Care Units (CICUs) registry, treated or not with MCS. Methods 324 sequential patients admitted with CS at a CICUs network between March 2020 and August 2022 were identified. We categorized patients according to treatment with MCS (n=204; 63%) and medical therapy (n=120; 37%). We investigated differences in clinical, laboratory, hemodynamics, echocardiographic and prognostic scores on admission, at 24-hours and at discharge. In-hospital outcome and mid-term survival were described for each treatment cohort. Comparison of continuous variables was performed using Student’s t-test. For categorical variables, the χ2 statistic was used. Results CS was a complication of acute myocardial infarction in 141 patients (44%) and of acute on chronic heart failure in 124 patients (38%); 58 patients (18%) presented with other diagnosis. In MCS cohort, we reported more advanced Society for Cardiovascular Angiography and Interventions (SCAI) shock stages and MCS implantation was more prevalent within 24-hours in SCAI C (48,6% on admission; 51,2% at 24-hours). In-hospital mortality did not differ between the two groups (38% in MCS and 37% in medically treated patients, p=0,874). Chronic kidney disease (OR 2.1, 95%CI 1.2-3.5, p=0,009), elevated lactates and SCAI stage at 24-hours (OR and 95%CI were, respectively, 3.45, 1.99-5.97 and 3.67, 2.46-5.47, p&amp;lt;0,001) emerged as major independent predictors of in-hospital mortality in MCS subgroup. A significant protective association persisted for those monitored with pulmonary artery catheter (OR 0.61, 95%CI 0.51-0.92, p=0.001). Among the 196 patients evaluated at mid-term follow up MCS treatment had not markedly improved cumulative survival compared to medical treatment (51,9% in MCS subgroup versus 55,6% in medical therapy, p=0,806). Palliative care team was rarely engaged (14% in MCS cohort vs 27% in medical therapy, p=0,83). Conclusions In this nation-wide study, mortality in MCS patients was high and no statistically significant difference on in-hospital and mid-term survival emerged between patients receiving MCS compared to medical therapy. Hence, a prompt and constant risk-stratification is mandatory to exclude patients too sick to derive any benefits from invasive therapies, avoiding futility.

AimsAge is an important risk factor for mortality among patients with cardiogenic shock and heart failure (HF). We sought to assess the extent to which age modified the performance of the Society for Cardiovascular Angiography and Interventions (SCAI) shock stage for in‐hospital and 1 year mortality in cardiac intensive care unit (CICU) patients with and without HF.Methods and resultsWe retrospectively reviewed unique admissions to the Mayo Clinic CICU during 2007–2015 and stratified patients by age and SCAI shock stage. The association between age and in‐hospital mortality was analysed using multivariable logistic regression, and 1 year mortality was analysed using Cox proportional hazards analysis, both in the entire cohort and among patients with an admission diagnosis of HF or acute coronary syndrome (ACS). The final study population included 10 004 unique patients with a mean age of 67 ± 15 years, including 46.1% with HF and 43.1% with ACS. Older patients more frequently had HF and had more extensive co‐morbidities, higher illness severity, more organ failure, and differential use of critical care therapies. The percentage of patients with SCAI shock stages A, B, C, D, and E were 46%, 30%, 16%, 7%, and 1%, respectively. Patients with HF were older, had greater severity of illness and higher SCAI shock stage, and had higher rates of death at all time points. In‐hospital mortality occurred in 908 (9%) patients, including 549 (12%) patients with HF (61% of all hospital deaths). Age was independently associated with hospital mortality (adjusted odds ratio per 10 years 1.3, 95% confidence interval 1.2–1.4, P < 0.001) and 1 year mortality (adjusted hazard ratio per 10 years 1.2, 95% confidence interval 1.2–1.3, P < 0.001) in the overall cohort. The associations of age with both hospital mortality (adjusted odds ratio 1.6 vs. 1.3 per 10 years older) and 1 year mortality (adjusted hazard ratio 1.5 vs. 1.3 per 10 years older) were higher for patients with ACS compared with patients with HF. Older age was associated with higher adjusted hospital mortality and 1 year mortality in each SCAI shock stage (all P < 0.05). Additive increases in both hospital mortality and 1 year mortality were observed with increasing age and SCAI shock stage.ConclusionsAge is an independent risk factor for mortality that modifies the relationship between the SCAI shock stage and mortality risk in CICU patients, providing robust risk stratification for in‐hospital and 1 year mortality. Although patients with HF had a higher risk of dying, age was more strongly associated with mortality among patients with ACS.

Background Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a critical form of mechanical circulatory support (MCS) for patients with refractory cardiogenic shock (CS). The combination therapy of VA-ECMO and Impella, known as ECPELLA, provides both systemic circulatory support and left ventricular (LV) unloading. However, whether the LV unloading effect of ECPELLA further reduces myocardial damage and mortality in Society for Cardiovascular Angiography and Interventions (SCAI) Stage E patients remains unclear. Objective To evaluate whether ECPELLA reduces myocardial damage and improves short-term survival in refractory CS patients with ST-elevation myocardial infarction (STEMI) requiring VA-ECMO before reperfusion. Methods Between January 2012 and January 2025, we retrospectively screened 239 acute coronary syndrome patients who required advanced mechanical circulatory support (MCS).Patients with non-STEMI, those who did not receive VA-ECMO during percutaneous coronary intervention (PCI) (n=81), and those with mechanical complications, such as left ventricular free wall rupture (n=8) or ventricular septal perforation (n=1), were excluded. Additionally, patients who had absent vital signs after MCS implantation and were deemed for withdrawal of care (n=7) were also excluded from the study. Ultimately, 77 consecutive STEMI patients who received VA-ECMO before reperfusion were included. Patients were divided into two groups: ECPELLA (n=48) and ECMO with IABP (n=28). Serum CK-MB levels and 30-day all-cause mortality were assessed. Results There were no significant differences between the groups in age, sex, coronary risk factors, left main trunk (LMT) lesion, or the rate of extracorporeal cardiopulmonary resuscitation (E-CPR). However, renal impairment (eGFR &amp;lt;60 mL/min/1.73 m²) was significantly more prevalent in the ECMO with IABP group. Additionally, the IABP-SHOCK II score, a prognostic score for CS, was significantly higher in the ECMO with IABP group than in the ECPELLA group (3 [3–4] vs. 4 [3–6]; p=0.015). The ECPELLA group had significantly higher MCS support flow per unit of body surface area during PCI and the first three days, received a significantly lower catecholamine dose, and demonstrated better lactate clearance. ECPELLA also resulted in significantly lower peak CK-MB levels (330 [115–562] IU/L vs. 500 IU/L; p=0.026). Kaplan-Meier analysis demonstrated a significantly higher 30-day survival rate in the ECPELLA group (p=0.003 by log-rank test). Multivariable Cox proportional hazard analysis, adjusting for age, E-CPR, LMT lesion, renal impairment, IABP-SHOCK II score, and ECPELLA, identified ECPELLA as the only independent factor associated with 30-day all-cause mortality (hazard ratio: 0.52, 95% confidence interval: 0.27–0.98; p=0.044). Conclusion ECPELLA treatment provides greater circulatory support and lower CK-MB levels, which may be associated with improved short-term survival compared to ECMO with IABP support.Figure1 Figure2

To the Editor, We previously performed an analysis of the academic output of anesthesiology departments across Canada from 2000-2004. Despite a steady increase in the total number of publications over this period, we identified a potentially concerning decrease in the number of randomized controlled trials (RCTs). Herein, we describe a follow-up analysis of publications by Canadian anesthesiology departments from 2005-2013 to evaluate whether the identified decrease in RCTs was a continuing trend. The search criteria were the same as those described for our previous analysis and included all publications (i.e., all publications with a digital object identifier from January 1, 2000 to December 31, 2013). All articles with a printed publication date were included in our analysis. The Pearson correlation coefficient (r value) was used to analyze overall publication trends among Canadian university anesthesiology departments. Average annual percent change and annual percent change (APC) were calculated using the Joinpoint Regression Program 4.0.4 (Statistical Research and Applications Branch, National Cancer Institute, USA). Our search identified 3,084 eligible articles, and we included 2,947 of these for analysis. We found a steady increase in both the total number of articles published from 2005-2013 (r = 0.86; 95% confidence interval [CI], 0.85 to 0.87) and the total number of publications from 2000-2013 (r = 0.91; 95% CI, 0.90 to 0.92) (Figure A). Using Joinpoint, APC analysis showed an average annual increase of 5.2% (95% CI, 3.8 to 6.5) for all publications from 2000-2013. A small but significant increase in total RCT publications occurred from 2005-2013 (r = 0.17; 95% CI, 0.06 to 0.28), contrasting with the decrease that was observed from 2000-2004 (r = -0.91). Our results show a slight overall increase in RCT publications throughout the entire period 2000-2013 (r = 0.26; 95% CI, 0.17 to 0.35) (Figure B). Analysis of APC with Joinpoint over this period showed an annual increase of 1.0% (95% CI, -1.7 to 3.9) for RCTs. Following the analysis of publications from 2005-2013, it was reassuring to see that the apparent declining trend in RCT publications did not continue beyond 2004. In fact, publication of RCTs showed a slight overall increase since 2000. This result is comparable with the findings of Pagel and Hudetz who studied the publication output of American anesthesiology departments. As shown in the Figure, the total number of publications and RCTs fluctuates from year to year, suggesting that the time frame covered in our original analysis may have been too small to provide an accurate depiction of publication trends. It is also reassuring that total publication activity increased in our latest period of analysis. A recent report by the Canadian Association of University Teachers reveals that the budget for the Canadian Institutes of Health Research, from which many medical researchers obtain their funds, fell 7.5% from 2007-2013. Although this finding is not indicative of budgetary decreases for other granting agencies, it does reflect the economic climate with regard to research funding in Canada over the last decade. Our findings suggest that lack of funding was not a major impediment to performing anesthesiology-related research during this period. As with the previous analysis, this study suffers from the possibility that institutions involved in multicentre or multidepartmental studies may be underrepresented since only the corresponding author’s institution was used in the search. The use of PubMed to perform our search likely D. K. M. Lam, BSc B. C. H. Tsui, MD (&) Department of Anesthesiology & Pain Medicine, University of Alberta, Edmonton, AB, Canada e-mail: btsui@ualberta.ca

One-time assessment of the Society for Cardiovascular Angiography and Interventions (SCAI) shock classification robustly predicts mortality in the cardiac intensive care unit (CICU). We sought to determine whether serial SCAI shock classification could improve risk stratification. Unique admissions to a single academic level 1 CICU from 2015 to 2018 were included in this retrospective cohort study. Electronic health record data were used to assign the SCAI shock stage during 4-hour blocks of the first 24 hours of CICU admission. Shock was defined as hypoperfusion (SCAI shock stage C, D, or E). In-hospital death was evaluated using logistic regression. Among 2918 unique CICU patients, 1537 (52.7%) met criteria for shock during ≥1 block, and 266 (9.1%) died in the hospital. The SCAI shock stage on admission was: A, 37.6%; B, 31.5%; C, 25.9%; D, 1.8%; and E, 3.3%. Patients who met SCAI criteria for shock on admission (first 4 hours) and those with worsening SCAI shock stage after admission were at higher risk for in-hospital death. Each higher admission (adjusted odds ratio, 1.36 [95% CI, 1.18-1.56]; area under the receiver operating characteristic curve, 0.70), maximum (adjusted odds ratio, 1.59 [95% CI, 1.37-1.85]; area under the receiver operating characteristic curve, 0.73) and mean (adjusted odds ratio, 2.42 [95% CI, 1.99-2.95]; area under the receiver operating characteristic curve, 0.78) SCAI shock stage was incrementally associated with a higher in-hospital mortality rate. Discrimination was highest for the mean SCAI shock stage (P<0.05). Each additional 4-hour block meeting SCAI criteria for shock predicted a higher mortality rate (adjusted odds ratio, 1.15 [95% CI, 1.07-1.24]). Dynamic assessment of shock using serial SCAI shock classification assignment can improve mortality risk stratification in CICU patients by quantifying the magnitude and duration of shock.

Alice K. Jacobs, MD, FACC, FAHA, Chair Jeffrey L. Anderson, MD, FACC, FAHA, Chair-Elect Nancy Albert, PhD, CCNS, CCRN, FAHA Mark A. Creager, MD, FACC, FAHA Steven M. Ettinger, MD, FACC Robert A. Guyton, MD, FACC Jonathan L. Halperin, MD, FACC, FAHA Judith S. Hochman, MD, FACC, FAHA

Timing of cardiogenic shock and clinical outcomes in takotsubo syndrome: A multicenter cohort study.

Cardiogenic shock complicating acute myocardial infarction is associated with a high mortality rate. Cardiogenic shock after out-of-hospital cardiac arrest (OHCA) can be due to transient myocardial stunning but also reflect the increasing severity of ongoing heart failure. The Society for Cardiovascular Angiography and Interventions (SCAI) proposed a division of cardiogenic shock into 5 phenotypes, with cardiac arrest being a modifier. The objective was to apply SCAI shock classification to a well-characterized OHCA population and describe the hemodynamic characteristics and prognostic significance of increasing SCAI classes. This is a post hoc analysis of data from the BOX (Blood Pressure and Oxygenation Targets in Post Resuscitation Care) trial of comatose patients with OHCA. Patients were classified according to SCAI class upon hospital admission. Invasive arterial and pulmonary arterial measurements were obtained the first 72 hours after admission, and perfusion pressure, cardiac index and cardiac power output were calculated. Of 789 patients included, 31.6% were classified as SCAI class B/C, 29.9% as SCAI class D, and 38.5% as SCAI class E. The first recorded perfusion pressure differed between SCAI class B/C, D, and E being lower in higher SCAI classes. The difference was found only at the first measurement. Cardiac index and cardiac power output did not differ at any time point between classes. The 1-year mortality rate increased with SCAI Class B/C to E (21.3%, 34.3%, and 48.4%, respectively; P<0.001). The 1-year mortality rate after OHCA increased with increasing SCAI classes, but cardiac index, cardiac power output, and perfusion pressure remained notably similar in the first 72 hours after admission. This challenges whether all OHCAs should be recorded as SCAI class E by default. URL: https://www.clinicaltrials.gov; Unique identifier: NCT03141099.

Funding Acknowledgements None. Background The mortality in cardiogenic shock (CS) remains high but the report mostly concerns CS in the course of acute myocardial syndrome (ACS). There is limited data about non- ischaemic CS. Purpose The aim of this study was to analyse the clinical characteristics, treatments and outcomes in patients with non-ACS CS in comparison to ischemic aetiology CS. Methods 80 patients with an average age of 62 ± 13 years (81 % male) with CS admitted in 2021 and 2022 to tertiary hospital were divided into 2 subgroups: non-acute myocardial infarction cardiogenic shock (non-ACS-CS) consisted of 16 individuals (20%) and CS in the course of ACS (ACS-CS) consisted of 64 (80%) individuals. The main cause of CS in non-ACS group was worsening of previously diagnosed heart failure 11 (14%). Results Patients from non-ACS group were younger 52±16 vs. 65±11 years old, p=0.005. There were no differences in baseline heart rate 90 [72;100] vs. 95 [80;107] beats per minute and mean artery pressure 89 [73;97] vs. 80 [70;97] mmHg for non-ACS-CS vs. ACS-CS, respectively all p&amp;gt;0.05. Patients from non-ACS-CS group had lower baseline troponin level 0.29 [0.04;0.96] vs. 7.05 [0.69;57.4] ng/mL, p=0.003, white blood cell count 11 [9;13] vs. 15 [10;19] × 109/L; p=0.035, procalcitonin 0.06 [0.05;0.28] vs. 0.69 [0.10;2,48] ng/mL, p=0.001 and higher pH 7.4 [7.3;7.5] vs. 7.2 [7.0;7.4], p=0.012 in blood gas analysis when compared with ACS-CS. There were no significant differences in the severity of the shock according to Society for Cardiovascular Angiography and Interventions (SCAI) SHOCK classification among the groups: from C: 1 (6%) vs. 6 (10%), D: 11 (69%) vs. 27 (42%), E: 4 (25%) vs. 31 (48%), respectively for non-ACS vs. ACS-shock. The non-ACS-CS was more often treated with V-A ECMO 10 (63%) vs. 20 (32%) in ACS-CS, p=0.024. The overall number of in-hospital deaths was 57 (71%). The non-ACS-CS group had significantly lower in-hospital mortality 8 (50%) compared to the ACS-CS patients 49 (77%), p=0.034. Conclusion Patients experiencing non-ACS-CS were younger, have lower levels of inflammatory markers and a higher pH in blood gas analysis at admission. Despite more favourable biomarker profile non-ACS-CS group was treated more aggressively and had significantly lower in-hospital mortality rates when compared with patients facing ACS-CS, which indicates the need to look at CS differently depending on its aetiology.

Trajectories and outcomes in patients with cardiogenic shock receiving heart replacement therapies.

Key points• The Extracorporeal Life Support (ECLS)-SHOCK is an investigator-initiated, multi-centre, open-label, randomized controlled trial (RCT), aimed at assessing whether early, unselective ECLS plus usual medical therapy might improve survival in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) undergoing early revascularization, as compared with standard medical therapy alone. 1• Cardiogenic shock was defined as (1) systolic blood pressure (SBP) of <90 mmHg for >30 min or the need for catecholamines to maintain an SBP of >90 mmHg, (2) arterial lactate levels of >3 mmol/L, and (3) signs of impaired organ perfusion (at least one of: altered mental status, cold or clammy skin and limbs, or urine output <30 mL/h).Patients had to be in Stage C (classic), D (deteriorating), or E (extremis) CS according to the Society for Cardiovascular Angiography and Interventions (SCAI) criteria, 2 with a planned early revascularization by either percutaneous coronary intervention (PCI) or coronary-artery bypass grafting.The exclusion criteria included cardiopulmonary resuscitation for >45 min, mechanical cause of CS, unfavourable vessel anatomy for veno-arterial extracorporeal membrane oxygenation (VA-ECMO) placement, and shock duration >12 h before randomization.• The primary endpoint was all-cause mortality at 30 days.Key secondary outcomes included time until haemodynamic stabilization, duration of intensive care unit hospitalization, acute kidney failure with the need for renal-replacement therapy, recurrent AMI, rehospitalization due to heart failure, poor neurologic outcome, and disease severity measured by lactate levels.Safety outcomes were moderate or severe bleeding, stroke or systemic embolization, and vascular complications warranting surgical or interventional therapy.• From June 2019 through November 2022, 417 patients (median age, 63 years; 19% female) were randomized 1:1 to receive either ECLS plus usual medical therapy (n = 209) or usual medical therapy alone (n = 208).The median lactate level before revascularization was 7 mmol/L (interquartile range, 5-10), 67% of patients had an ST-segment elevation myocardial infarction, and 78% underwent cardiopulmonary resuscitation before randomization.Extracorporeal Life Support treatment was initiated during the index angiography in the majority of patients (92%), and PCI was performed in 97% of cases.Veno-arterial extracorporeal membrane oxygenation was not initiated in 8% of the patients in the ECLS group, while 26 patients in the control group (12%) underwent VA-ECMO during the study.Escalation therapy using other devices was performed in 28 patients (15% of the control group), and an intravascular micro-axial left ventricular assist device was the most frequently used (86%).The use of at least one left ventricular unloading strategy was reported in 6% of the ECLS group.• One hundred patients in the ECLS group (48%) and 102 in the control group (49%) died at 30 days [relative risk (RR), 0.98; 95% confidence interval (CI), 0.80-1.19;P = .81].No major differences were observed for secondary outcomes between the groups, and results were consistent across all subgroups (sex, age, diabetes, type of acute coronary syndrome, lactate levels, and cardiopulmonary resuscitation) in prespecified and post hoc analyses.• Moderate or severe bleeding was higher in the ECLS group than in the control group (RR, 2.44; 95% CI, 1.50-3.95),as was the rate of peripheral ischaemic vascular complications warranting intervention (RR, 2.86; 95% CI, 1.31-6.25).

Aim. To determine preimplantation risk factors and predictors of unfavorable outcome in patients with cardiogenic shock after open-heart surgery, who had an intraoperative system of mechanical circulatory support – intra-aortic balloon contrapulsation. Methods. A retrospective study was conducted at the Republican Scientific and Practical Center “Cardiology” for 2015–2020. It included 66 patients who underwent heart surgery on bypass and who intraoperatively developed cardiogenic shock, refractory to drug therapy, which resulted in the use of intra-aortic balloon counterpulsation. The diagnosis of cardiogenic shock was determined based on the generally accepted criteria, as well as based on the SCAI (Society for Cardiovascular Angiography and Interventions) classification of shock: systolic blood pressure &lt; 90 mmHg for &gt; 30 minutes or the need for infusion of vasopressors or inotropes to achieve the blood pressure of ≥ 90 mm Hg. The Pearson Chi-square test used for nonparametric analysis of qualitative characteristics. The predictors were identified based on logistic regression. Differences were considered significant at p &lt; 0.05 (5%).Results. Risk factors for adverse outcome in case of CS before the use of IABP were: age over 65 years OR = 6.04 [95% CI 1.73 – 21.06], p = 0.003; female gender OR = 3.24 [95% CI 1.064 – 9.873], p = 0.048; vasoactive and inotropic support of more than 42 points OR = 7.85 [95% CI 2.33 – 26.45], p = 0.001; blood lactate of more than 4.7 mmol/l OR = 4.12 [95% CI 1.27 – 13.37], p = 0.014; blood acidity pH &lt; 7.33 OR = 6.34 [95% CI 1.97 – 20.37], p = 0.003; base deficit BE &gt; –5.6 OR = 7.32 [95% CI 2.19 – 24.42], p = 0.001. According to the β-coefficients of the logistic regression equation, predictors were scored as follows: age &gt; 65 years = 2 points, VIP &gt; 42 = 2 points, lactate &gt; 4.7 mmol/L = 1 point. The cumulative probability of 30-day mortality was as follows: 9% when defined as 1 point, 20% – 2 points, 55% – 3 points, 60% – 4 points, 75% – 5 points (Chi-square 24.1; df = 5; p = 0.001). Conclusions. Cardiogenic shock is a fatal complication in cardiac surgery. The use of vasopressor and inotropic drugs has an important role in the treatment of CS; however, escalation of catecholamine doses leads to the progression of multiple organ failure due to hypoperfusion and hypoxia of target organs. Therefore, the use of intra-aortic balloon counterpulsation can improve the results of CS treatment. However, the effect of IABP is limited to increasing cardiac output by no more than 1 l/minute. Based on the calculator we developed, when determining a high risk of an unfavorable outcome of the IABP use, options for circulatory support should be considered including extracorporeal membrane oxygenation, ventricular assist device.

Cardiogenic Shock in Non-Ischemic Cardiomyopathy: Dynamic Mechanical Circulatory Support and Pathophysiology Illustration