Cardiogenic shock in France: What and who are we talking about? A descriptive analysis of the FRENSHOCK multicenter prospective registry

Background Epidemiologic data about cardiogenic shock (CS) are still poor and focused on ischemic CS, forgetting all part of the CS encountered in clinical practice. Methods FRENSHOCK registry (NCT02703038) was a large prospective multicenter registry of non-selected CS patients admitted in critical care units realized between April and October 2016 in France. Patients were included if they met the following three criteria: – low cardiac output defined by SBP  2 (TTE or Swan–Ganz); – elevation of left and/or right heart pressures defined by clinic/radiology/biology/echocardiography/Swan-Ganz; – clinical and/or biological hypoperfusion. Results In total, 772 patients were included in 48 centers (male 72%, mean age of 66y). Comorbidities associated previous coronary revascularization 26%, peripheral arterial disease 15%, renal failure 21%, COPD 6%, diabetes 28%, tobacco 28%, dyslipidemia 35% and hypertension 47%. 56% were known for previous cardiomyopathy (30% ischemic, 10% idiopathic, 8% valvular). CS etiology often associated several triggers: ischemic was retained for 36% (type 1 infarction 17%). Non-ischemic trigger factors were predominant (64%): supra-ventricular (13%) and ventricular arrythmia (13%), infection (12%), iatrogenic (6%), conductive disorders (2%), non-observance (4%), and others (14%). At admission median SBP was 101.2 mmHg. Right heart failure signs were present in 49% and left signs in 72% (Killip IV 49%). Biological analysis found high lactate (3.0 mmol/L), renal (eGFR 49.6 ml/min) and hepatic alteration (ASAT 90.0 UI/ml; PT 57.1%). Median LVEF was 26.3% and TAPSE 13.4 mm. When realized (52%) coronarography was pathological in 81% (monotroncular 31%, bitroncular 35% and tritroncular 34%). A culprit lesion (79%) concern LVA 48%, RCA 23% and left main 15%. Conclusion CS presentation and etiology are heterogeneous with a predominance of non-ischemic CS in practice.