AIMS: Despite its high incidence and mortality risk, there is no evidence-based treatment for non-ischaemic cardiogenic shock (CS). The aim of this study was to evaluate the use of mechanical circulatory support (MCS) for non-ischaemic CS treatment. METHODS AND RESULTS: In this multicentre, international, retrospective study, data from 890 patients with non-ischaemic CS, defined as CS due to severe de-novo or acute-on-chronic heart failure with no need for urgent revascularization, treated with or without active MCS, were collected. The association between active MCS use and the primary endpoint of 30-day mortality was assessed in a 1:1 propensity-matched cohort. MCS was used in 386 (43%) patients. Patients treated with MCS presented with more severe CS (37% vs. 23% deteriorating CS, 30% vs. 25% in extremis CS) and had a lower left ventricular ejection fraction at baseline (21% vs. 25%). After matching, 267 patients treated with MCS were compared with 267 patients treated without MCS. In the matched cohort, MCS use was associated with a lower 30-day mortality (hazard ratio 0.76, 95% confidence interval 0.59-0.97). This finding was consistent through all tested subgroups except when CS severity was considered, indicating risk reduction especially in patients with deteriorating CS. However, complications occurred more frequently in patients with MCS; e.g. severe bleeding (16.5% vs. 6.4%) and access-site related ischaemia (6.7% vs. 0%). CONCLUSION: In patients with non-ischaemic CS, MCS use was associated with lower 30-day mortality as compared to medical therapy only, but also with more complications. Randomized trials are needed to validate these findings.

Anesthesia and Intensive Care Fondazione Policlinico San Matteo Hospital IRCCS Pavia Italy

Cardio Center Humanitas Clinical and Research Center IRCCS Milan Italy

Department of Cardiology and Angiology University Heart Center Freiburg Germany

Department of Cardiology and Vascular Medicine West German Heart and Vascular Center University Hospital Essen Essen Germany

Department of Cardiology Charité Universitätsmedizin Berlin Berlin Germany

Department of Cardiology IKEM Prague Czech Republic

Department of Cardiology Paracelsus Medical University Nürnberg Nürnberg Germany

Department of Cardiology Pulmonology and Vascular Medicine Heinrich Heine University Düsseldorf Düsseldorf Germany

Department of Cardiology University Heart and Vascular Center Hamburg Hamburg Germany

Department of Cardiology Ziekenhuis Oost Limburg Genk Belgium

Department of Cardiothoracic Surgery University Heart and Vascular Center Hamburg Hamburg Germany

Department of Clinical Surgical Diagnostic and Paediatric Sciences University of Pavia Pavia Italy

Department of Internal Medicine 1 University Hospital Jena Jena Germany

Department of Internal Medicine 1 University Hospital Würzburg Würzburg Germany

Department of Internal Medicine and Cardiology Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute Leipzig Germany

Department of Perioperative Medicine St Bartholomew's Hospital London UK

Dept Cardiothoracic and Vascular Anesthesia and Intensive Care AO SS Antonio e Biagio e Cesare Arrigo Alessandria Italy

Doctoral School for Medicine and Life Sciences LCRC Diepenbeek Belgium

German Center for Cardiovascular Research Partner site Hamburg Kiel Lübeck Hamburg Germany

Herzzentrum Dresden Technische Universität Dresden Dresden Germany

IRCCS Santa Maria Nascente Fondazione Don Carlo Gnocchi ONLUS Milan Italy

Medizinische Klinik 2 Kliniken Nordoberpfalz AG Weiden Germany

Medizinische Klinik und Poliklinik 1 Klinikum der Universität München Munich Germany

Unità di Cure Intensive Cardiologiche and De Gasperis Cardio Center ASST Grande Ospedale Metropolitano Niguarda Milan Italy

University Heart Center Lübeck University Hospital Schleswig Holstein Lübeck Germany

University Medical Center Hamburg Eppendorf Department of Intensive Care Medicine Hamburg Germany

Eur J Heart Fail. 2023 Apr;25(4):573-575. doi: 10.1002/ejhf.2826. PubMed

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