Trajectories and outcomes in patients with cardiogenic shock receiving heart replacement therapies

Van-Khue Ton; Qiuyue Kong; Manreet K Kanwar; Elric Zweck; Jonas Sundermeyer; Song Li; Shashank S Sinha; Jaime Hernandez-Montfort; Arthur Reshad Garan; Rachna Kataria; Jacob Abraham; Daniel Burkhoff; Navin K Kapur; CSWG Academic Research Consortium

doi:10.1016/j.healun.2026.03.037

Trajectories and outcomes in patients with cardiogenic shock receiving heart replacement therapies

J Heart Lung Transplant. 2026 Apr 6:S1053-2498(26)01828-0. doi: 10.1016/j.healun.2026.03.037. Online ahead of print.

Affiliations

¹ The Mass General Brigham Heart and Vascular Institute, Massachusetts General Hospital, Boston, MA.
² The Cardiovascular Center, Tufts Medical Center, Boston, MA.
³ University of Chicago, Chicago, IL.
⁴ Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany.
⁵ The Cardiovascular Center, Tufts Medical Center, Boston, MA; Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany.
⁶ Institute for Advanced Cardiac Care, Medical City Healthcare, Dallas, TX.
⁷ Inova Schar Heart and Vascular Institute, Falls Church, VA.
⁸ Warren Clinic, St. Francis Health, Tulsa, OK.
⁹ Beth Israel Deaconess Medical Center, Boston, MA.
¹⁰ Brown University Health Cardiovascular Institute, Providence, RI.
¹¹ Center for Cardiovascular Analytics, Research, & Data Science (CARDS), Providence St. Joseph Research Network, Portland, OR.
¹² Cardiovascular Research Foundation, New York, NY.
¹³ The Cardiovascular Center, Tufts Medical Center, Boston, MA. Electronic address: Nkapur@tuftsmedicalcenter.org.

PMID: 41951134
DOI: 10.1016/j.healun.2026.03.037

Abstract

Background: Data describing trajectories of cardiogenic shock (CS) patients undergoing heart replacement therapies (HRT) remain limited. We aimed to compare CS patients receiving HRT vs none during index CS hospitalization.

Methods: We retrospectively analyzed the Cardiogenic Shock Working Group (CSWG) registry (2021-2024). CS severity was characterized using CSWG definitions of Society for Cardiovascular Angiography and Interventions (SCAI) stages, machine learning-derived phenotypes, and the Comorbidity Risk Index for CS (COMRI-CS).

Results: Among 7,750 patients, 1,187 (15.3%) received HRT. Compared with the no-HRT cohort, HRT recipients were younger (57 [47-65] vs 64 [54-73] years, p < 0.001) and more likely to have heart failure-related CS (84.9% vs 55.8%, p < 0.001). They had more baseline CSWG-SCAI stages A (18.1% vs 11.4%), C (14.3% vs 8.1%), and D (44.5% vs 35.9%), but less stages B (14.7% vs 16.9%) and E (8.4% vs 27.7%; all p < 0.001). They had fewer comorbidities (high COMRI-CS risk: 2.8% vs 5.8%, very high risk: 0% vs 0.9%), fewer phenotype III (7.3% vs 21.4%), and lower mortality (6.2% vs 34.1%, all p < 0.001), despite higher complication rates. In a propensity score-matched cohort (3 no-HRT:1 HRT), HRT was associated with improved survival (OR 0.11, 95% CI 0.08-0.16, p < 0.001), whereas complications predicted death (OR 2.0, 95% CI 1.81-2.21, p < 0.001).

Conclusion: CS patients receiving HRT exhibited less SCAI stage E and phenotype III, more favorable COMRI-CS profiles, and lower mortality despite higher complication rates. Robust risk predictors for post-HRT outcomes in CS are needed.

Keywords: Cardiogenic shock; Heart replacement therapies; Heart transplant; Left ventricular assist device; Mortality.