Poster 034: Phenotype-Specific Outcomes and Advanced-Therapy Trajectories in Cardiogenic Shock Supported With Temporary MCS: HF-CS vs AMI-CS Systematic Review and Meta-analysis

Background: Heart failure–related cardiogenic shock (HF-CS) and acute myocardial infarction–related cardiogenic shock (AMI-CS) represent distinct phenotypes with different expectations for reversibility and destination therapy. We compared outcomes and advanced-therapy trajectories between HF-CS and AMI-CS among patients supported with temporary mechanical circulatory support (tMCS).

Methods: We conducted a systematic review of studies comparing HF-CS versus AMI-CS among adult patients treated with tMCS. Eligible studies reported phenotype-stratified outcomes. Random-effects meta-analyses were performed for short-term mortality and native heart survival (NHS), when explicitly defined. Advanced-therapy outcomes, including heart transplantation, left ventricular assist device (LVAD), and heart replacement therapy (HRT), were analyzed using pooled odds ratios (ORs) where feasible or summarized descriptively when reporting was heterogeneous. Mantel–Haenszel methods were used with continuity correction for zero-event studies. Heterogeneity was assessed using the I² statistic.

Outcome: Thirteen studies contributed to mortality analysis (HF-CS n=2,697; AMI-CS n=2,102). HF-CS was associated with lower odds of short-term mortality compared with AMI-CS (OR 0.40, 95% CI 0.28–0.57; I²=60.2%).

NHS was reported in six studies (HF-CS n=2,365; AMI-CS n=1,494) and favored AMI-CS (OR 0.29, 95% CI 0.20–0.41; I²=94.5%).

Advanced-therapy transitions were markedly more frequent in HF-CS. Heart transplantation (7 studies; HF-CS n=1,364; AMI-CS n=594) strongly favored HF-CS (OR 10.39, 95% CI 5.52–19.55; I²=0%). HRT (9 studies; HF-CS n=2,545; AMI-CS n=1,558) was more common in HF-CS (OR 7.98, 95% CI 5.24–12.15; I²=76.2%). LVAD implantation (8 studies; HF-CS n=2,138; AMI-CS n=1,174) also favored HF-CS (OR 2.43, 95% CI 1.47–4.03; I²=75.1%)

Conclusion: Among patients with cardiogenic shock supported with tMCS, HF-CS and AMI-CS demonstrate distinct support trajectories. HF-CS shows lower pooled short-term mortality but markedly higher transition to advanced therapies, while AMI-CS more frequently achieves native-heart survival. Phenotype-specific reporting is essential for interpreting MCS outcomes.