International cooperation in cardiogenic shock is key to improving outcomes: Cardiogenic Shock Working Group impacts a single center in a developing country

Abstract

The Cardiogenic Shock Working Group (CSWG) is an international research consortium formed in 2016. The National Institute of Cardiology Ignacio Chavez joined in 2021 and launched a cardiogenic shock (CS) program in 2022. This study evaluates the impact of CSWG core standards on outcomes in a middle-income country reference center of 9,430 patients with CS (Society for Cardiovascular Angiography and Interventions [SCAI] stages B→E) from a registry of 28,054 admissions (2005-2023). Using multivariate Cox regression and propensity score matching, outcomes were compared between historic pre-CSWG (2005-2021) and contemporary pre-CSWG (2017-2021) eras vs the CSWG era (2022-2023). Adoption of CS-team standards increased the use of pulmonary artery catheters (4.2%, 4% vs 7.9%, p < 0.001) and mechanical circulatory support devices (8.1% to 10.3%, p = 0.014) only in the legacy era. Reducing mortality from 22.3% and 20.5% vs 15.3% (p < 0.001). The adjusted hazard ratio for mortality in the pre-CSWG era was 1.22 (p = 0.015) for the historical cohort and 1.20 (p = 0.047) for the contemporary cohort. CS-international collaboration enhanced outcomes through standardized protocols, advanced interventions, and dedicated CS teams, underscoring the importance of international cooperation in CS care.

Keywords: cardiogenic shock; international cooperation; mechanical circulatory support; pulmonary artery catheter; shock teams.