Association of Hemo-Metabolic Trajectory and Cardiogenic Shock Mortality: Analysis from the CSWG Registry

Background: Prior Cardiogenic shock (CS) studies have reported hemodynamic parameters associated with mortality in limited cohorts or at single time points. Hemodynamic trajectories have not been described. Objectives: We studied the association between hemodynamics and in-hospital mortality in patients with CS due to heart failure (HF-CS) and acute myocardial infarction (AMI-CS). Methods: Using data from the Cardiogenic Shock Working Group (CSWG) registry, we analyzed hemo-metabolic data obtained at the time of pulmonary artery catheter (PAC) insertion (baseline) and at PAC removal or death (final). Univariable regression analyses for prediction of in-hospital mortality were conducted for baseline, final hemo-metabolic values, as well as the interval change (delta-P), and analyzed based on CS etiology and survival status. Results: 2,260 patients with PAC data were included (70% male, age 61±14, 61% HF-CS, 27% AMI-CS). In-hospital mortality was higher in the AMI-CS group (40.1% vs 22.4%, p<0.001). In the HF-CS cohort, survivors exhibited lower right atrial pressure (RAP), pulmonary artery pressures (PAP), cardiac output/index (CO/CI), lactate and higher blood pressure (BP) than non-survivors at baseline. During hospitalization, improvement in metabolic (AST, lactate), BP, hemodynamic (RAP, PAPi, PA compliance for right hemodynamics and CO/CI for left), had association with survival. In the AMI-CS cohort, a lower systolic BP and higher PAP were associated with odds of death at baseline. Improvement in lactate, BP, hemodynamic (RAP, PAPi for right hemodynamics and CO/CI for left) were associated with survival. Conclusions: In a large contemporary CS registry, few hemo-metabolics at baseline determined survival in AMI-CS; rather hemodynamic trajectories had a strong association with outcomes in both cohorts. These findings suggest the importance of monitoring hemo-metabolic trajectories to tailor management in patients with CS. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement No external funding was received ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: All individual centers who participated in the Cardiogenic Shock Working Group Registry registry are required to obtain appropriate IRB approval from the individual sites to participate in the registry, which are updated periodically/ as required. Unidentified data is then shared with the (central) data coordinating center located at Tufts University, Boston, Massachusetts under the provisions of approved data user agreements between individual sites and Tufts University. The data is collected by individual centers from electronic health records using prespecified case report forms in a retrospective fashion. Ethics approval was neither sought nor waived. No data was collected or shared prior to IRB approval or without appropriate data user agreements " I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The data included in the manuscript is accurate and available