Study: One in four early cardiogenic shock patients experience worse outcomes

In one of the largest studies of early cardiogenic shock (CS) patients, where blood flow is still functioning to vital organs, researchers demonstrated that 26% experienced worse outcomes, including care escalation, CS deterioration, or in-hospital mortality. The data were presented today as late-breaking clinical research at the Society for Cardiovascular Angiography & Interventions (SCAI) 2025 Scientific Sessions.

CS is a life-threatening condition in which the heart cannot pump enough blood to meet the body's needs. As a result, your blood pressure may suddenly drop to dangerous levels, and if CS isn't diagnosed and treated quickly, it's often fatal. In fact, the efficiency of the heart decreases, resulting in low blood flow. Nearly 50% of patients with CS never make it out of the hospital. While there is widespread acknowledgement of the seriousness of late-stage CS, there is little research on the clinical outcomes of patients who are at the earlier stage.

The retrospective study evaluated 500 patients with Stage B CS admitted to the medical, intermediate care, and critical care units of six hospitals of the Brown University Health system. SCAI's SHOCK classification identifies Stage B CS as beginning or early CS, wherein the cardiac dysfunction has not yet fully manifested itself. SCAI B CS was defined as hypotension (systolic blood pressure of ≤ 90 or a mean blood pressure ≤ 65 mmHg) over two consecutive measurements or hypoperfusion (blood lactate level of 2-5 mEq/L) in those with primary cardiac etiologies or causes. Cardiac arrest, use of circulatory support, sepsis, hypovolemia, and non-cardiac etiologies were excluded. The composite primary endpoint included transfer to a higher level of care, deterioration of CS, or in-hospital mortality. The etiology of the CS included heart failure (42%), arrhythmia (25%), acute myocardial infarction (13%), structural disease (3%), and a combination of the above (17%).

132 patients (26%) were transferred to a higher level of care, experienced deterioration of CS, and/or in-hospital mortality (49.2%, 62.1%, and 40.9%, respectively). The median time to the primary endpoint was 16 (IQR 5.5-48) hours, relatively fast for this population group. Patients experiencing the primary endpoint had lower admission blood pressure, left ventricular ejection fraction, and 24-hour urine output, higher acute kidney injury (AKI), bacteremia, and liver injury rates (all p<0.05).

Despite being labeled "early" cardiogenic shock, these patients are thought to be typically not nearly as sick as those patients with classically manifested cardiogenic shock. The study showed that more than one in four patients with early CS experience poor outcomes, highlighting the need to collaborate across disciplines to recognize symptoms and diagnose these patients sooner in order to potentially improve patient outcomes." 

Saraschandra Vallabhajosyula, MD MSc, Assistant Professor of Medicine at Warren Alpert Medical School of Brown University; Interventional and Critical Care Cardiologist and CCU Director at Brown University Health Cardiovascular Institute and senior author of the study