794 Association of Hospital Characteristics and Clinical Outcomes in Patients Presenting With Cardiogenic Shock Due to Acute Coronary Syndromes

Cardiogenic shock (CS) remains a grave complication of acute coronary syndrome (ACS) with high mortality rates despite timely reperfusion and improved advanced heart failure therapies. We analysed data from consecutive patients with CS complicating ACS who underwent PCI and prospectively enrolled in the Victorian Cardiac Outcomes Registry from 26 hospitals in the state of Victoria between 2013-2018. We assessed the relationship of availability of cardiac surgery at the hospital where PCI was performed as well as CS PCI volume (stratified into tertiles of <10, 10-25, >25 cases per year) with in-hospital and long-term mortality. Of 1,187 patients with CS undergoing PCI, the mean age of patients was 65 years; males comprised 74%; 21.5% had diabetes mellitus and 15.6% had prior PCI. Cardiac arrest occurred in 37.6% of patients while 90% presented with ST-elevation myocardial infarction and 26% received intra-aortic balloon pump support. Overall in-hospital and long-term mortality were 42% and 50.5% respectively. There was no difference in in-hospital and long-term mortality among patients treated at cardiac surgical centres compared to non-surgical centres (Figure). Similarly, there was no association between tertiles of CS PCI volume with in-hospital mortality (44% vs 41% vs 41%, p=0.69) and long-term mortality (55% vs 48% vs 49%, p=0.13). Persistently high CS-related mortality appeared independent of cardiac surgery availability and CS PCI volume underscoring the lack of effective interventions and mechanical circulatory support. Prospective studies are needed to further evaluate the impact of streamlined systems of care and CS PCI volume on mortality.