From prediction to treatment in cardiogenic shock - can we do better?

This thesis focuses on cardiogenic shock (CS) in the context of acute coronary syndrome (ACS), using data from the Dutch percutaneous coronary intervention (PCI) population. It begins by identifying key risk factors for developing CS—such as older age, diabetes, renal dysfunction, and prior cardiac events—based on a cohort of over 75,000 patients, highlighting the significantly higher short-term mortality associated with CS.
To further explore the characteristics and outcomes of CS patients, a dedicated national registry was established. This provided deeper insight into clinical presentations, treatment strategies, and predictors of mortality. Non-survivors typically showed signs of more severe illness at admission, including lower blood pressure, elevated heart rate, and higher lactate levels.
The thesis also presents the development and validation of a clinical prediction model for 30-day mortality in patients with acute myocardial infarction and CS (AMI-CS). This model incorporates a range of clinical and biochemical parameters, supporting more informed decision-making and improved comparability across studies and clinical trials.
Sex-specific differences in AMI-CS were also explored, revealing notable distinctions in presentation and treatment between men and women, though outcomes were similar. Furthermore, access site for PCI in CS patients was studied, showing that while radial access was less commonly used, it was associated with better outcomes compared to femoral access, which tended to be used in sicker patients.
Finally, the thesis introduces the Norshock trial, a randomized study currently underway, which investigates whether reducing the use of noradrenaline in AMI-CS improves survival and kidney outcomes.