Abstract 13324: One-Year Outcomes in Patients With Cardiogenic Shock: Insights From the Inova-Shock Registry

Introduction: Historically, studies have focused on short-term morbidity and mortality associated with cardiogenic shock (CS). Little is known about post discharge outcomes following acute myocardial infarction (AMI-CS) as compared to acute decompensated heart failure (ADHF-CS). Methods: We examined 520 (219 AMI-CS, 301 ADHF-CS) consecutive patients with CS (1/3/2017-12/31/2019) in a single center registry. Results: Median duration of post discharge follow up was 433 days (IQR, 199-699). Mean age was 61.5±13.5 years, 71% were male, and 64% had chronic kidney disease. The AMI-CS cohort was older (65.6 vs. 58.5, p <0.001), had more cardiac arrest (35.2% vs. 16.0%, p < 0.001), higher baseline lactates (2.7 vs. 2.2, p < 0.01), and decreased pulmonary artery pulsatility indices (1.21 vs. 1.50, p < 0.01). AMI-CS patients had higher in-hospital mortality (38.8% vs. 24.6%, p< 0.001) and at 30 days (46.1% vs. 31.9%, p =0.01) as compared to ADHF-CS. However, this difference was no longer significant at 12 months (52.9% vs. 44.3%, p =0.07). Patients with low (0-3), intermediate (4-5), and high-risk (6-9) CardShock scores on admission had 12-month mortalities of 18.3%, 42.5%, and 82.0%, respectively. For the 361 (69.4%) patients who survived to discharged, 28.9% (n=98) experienced a Major Adverse Cardiovascular Events (MACE) at least once in the 12 months post discharge and 22.7% (n=82) were readmitted within 30 days. There was no significant difference in the occurrence of MACE between the two cohorts (AMI-CS= 27.2% vs ADHF-CS= 31.9%, p=0.57) but the 30-day readmission rate was lower in the AMI-CS cohort as compared to the ADHF-CS group (19.6% vs 24.8%, p< 0.01). Conclusions: There is substantial one-year morbidity and mortality in patients with AMI-CS and ADHF-CS. The AMI-CS cohort had higher in-hospital mortality, which persisted post discharge, as compared to ADHF-CS patients. CardShock risk stratification may be useful for longer term prognostication in CS patients.