Prevalence and Prognostic Impact of Coronary Chronic Total Occlusions in Patients With Cardiogenic Shock

Background: Mortality in patients with cardiogenic shock (CS) remains high despite advanced treatment strategies in CS patients, underlining the need for the identification of predictors of prognosis in CS patients. Therefore, the present study investigates the prognostic impact of coronary chronic total occlusions (CTO) in patients with CS. Methods: All consecutive patients being acutely admitted with CS to an intensive care unit (ICU) and undergoing invasive coronary angiography (ICA) from 2019 to 2021 were included, irrespective of the etiology of CS. Patients with at least one CTO were compared to non-CTO patients with regard to the risk of all-cause mortality at 30 days. Further risk stratification was performed according to the extent of coronary artery disease (CAD). Results: A total of 192 CS patients undergoing ICA during index hospitalization were included. At least one CTO was present in 24% of CS patients. Patients with CTO were older (median 78 vs. 68; p = 0.001) and presented more frequently with non-ST-elevated myocardial infarction (21% vs. 12%; p = 0.048). The presence of a CTO was associated with higher rates of 30-days all-cause mortality (70.2% vs. 47.6%; HR = 1.783, 95% CI 1.176-2.702; p = 0.009), even after multivariable adjustment (adjusted HR = 1.898; 95% CI 1.116-3.229; p = 0.018). Patients with CTO were accompanied by an even higher 30-days all-cause mortality as compared to patients with multi-vessel CAD without CTO (adjusted HR = 1.723; 95% CI 1.058-2.805; p = 0.029). Conclusion: Coronary CTO are common in patients with CS and represent an independent predictor of all-cause mortality at 30 days.