Vol. 6, Issue 2, Part C (2024)

Background: Cardiogenic shock (CS) represents the most severe form of acute heart failure (AHF) syndrome. CS is a low cardiac output (CO) state primarily due to cardiac dysfunction, leading to severe end-organ hypoperfusion with ultimate multiorgan failure and death. Despite advanced management, the in-hospital mortality rate is still between (30-50%), depending on the underlying etiology. The aim of this work was to give a comprehensive view of the current CS patients' characteristics, etiologies, management options offered to them, in-hospital outcomes.
Methods: This prospective observational cohort registry study was carried out on 300 patients with clinical criteria of low CO, defined by systolic blood pressure < 90 mmHg and/or the need for vasoactive medications to maintain systolic blood pressure > 90 mmHg and/or cardiac index < 2.2 L/min/m2 on echocardiography or right heart catheterization, elevation of left and/or right heart pressures.
Results: ACS is by far the most common cause of cardiogenic shock. Most of our cohort who underwent invasive coronary strategy had three-vessel disease and the LAD artery was the most common culprit artery. the under-utilization of substantial tools needed for either optimal monitoring, diagnostic purposes or guiding therapy like (invasive arterial line, pulmonary artery catheter, procalcitonin, plasma lactate, and natriuretic peptide testing), the absence of use of any form of short-term MCS. In-hospital mortality rate in our registry was markedly higher comparable to western data. STEMI diagnosis, medical history of PCI and atrial fibrillation\ flutter rhythm were significant independent predictors of in-hospital mortality in our study. 
Conclusions: Acute coronary syndrome was by far the most common cause of CS in our cohort with a higher mortality rate comparable to western data. We had a high prevalence of some cardiovascular risk factors like smoking, diabetes mellitus, and CKD. The remarkable underuse of short-term MCS devices and the absence of a consistent shock care pathway, including efficient pre-hospital care, an emergency medical system, dedicated, well-equipped cardiac shock centres, and a standardized multidisciplinary cardiac shock team.