Organ perfusion pressure predicts outcomes in cardiogenic shock patients

Aims: The diagnosis of cardiogenic shock (CS) relies upon signs and/or symptoms of end-organ hypoperfusion. The combination of hypoperfusion and systemic congestion identifies patients at particularly high risk. This study evaluated organ perfusion pressure (OPP), calculated as mean arterial pressure minus invasive central venous pressure, as a predictor of outcomes in CS. Methods and results: All consecutive patients with acute myocardial infarction-related CS (AMI-CS) or acutely decompensated heart failure-related CS (ADHF-CS) enrolled in the multicentre Altshock-2 registry between January 2020 and November 2023 were included. The primary outcome was in-hospital all-cause mortality. Overall, 316 patients were included (mean age: 64 ± 13 years, 62 [20%] female, median left ventricular ejection fraction: 22% [interquartile range, IQR 15–30%], 261 [85.9%] SCAI stage C or worse, median OPP at presentation: 57.0 mmHg [IQR 47.0–69.8 mmHg]). A total of 117 (37%) patients died during the hospitalization. Low OPP (i.e. <57.0 mmHg) was associated with significantly higher in-hospital all-cause mortality (hazard ratio [HR] 1.757, 95% confidence interval [CI] 1.208–2.556, p = 0.003), whereas low mean arterial pressure alone was not (HR 1.323, 95% CI 0.901–1.941, p = 0.153). After multivariable adjustment for significant clinical data available at first bedside assessment (age and Sequential Organ Failure Assessment score), low OPP still predicted significantly higher in-hospital all-cause mortality (HR per mmHg decrease: 1.016, 95% CI 1.004–1.029, p = 0.010). Low OPP appeared particularly powerful in predicting higher in-hospital all-cause mortality among ADHF-CS patients (HR 3.172, p = 0.002). Conclusion: In this multicentre, observational, prospective study on patients hospitalized for CS, lower OPP on admission was associated with significantly higher in-hospital all-cause mortality.