Clinical impact of congestion in patients admitted for cardiogenic shock - 11/03/26
, François Roubille c, Eric Bonnefoy d, Paul Gautier a, b, Etienne Puymirat e, Guillaume Baudry f, g, Bruno Levy h, Pascal Lim i, Laurent Bonello j, Hamid Merdji k, Meyer Elbaz a, b, Clément Delmas a, bGraphical abstract |
Highlights |
• | We studied a large cohort of unselected patients with CS. |
• | Clinical congestion was reported in nearly 90% of patients. |
• | Congestion is frequent in patients with CS. |
• | Congestion often persists beyond 24 hours of management. |
• | Congestion is significantly associated with a higher 30-day all-cause death rate. |
• | The 30-day all-cause death rate is even greater for persistent congestion. |
• | Further studies are warranted to clarify optimal decongestion strategies in CS. |
Abstract |
Background |
Recent guidelines have proposed dichotomizing acute heart failure and cardiogenic shock phenotypes based on signs/symptoms of hypoperfusion/congestion.
Aim |
We aimed to assess the prognostic significance of congestion and its early evolution during the first 24 hours in a nationwide cardiogenic shock cohort.
Methods |
FRENSHOCK was a prospective registry including 772 patients with cardiogenic shock from 49 centres. Patients were classified as cold and wet or cold and dry according to congestive signs. Death at 30 days was analysed according to baseline phenotype.
Results |
Among 593 patients with cardiogenic shock included, 70.7% were male; the median age was 67.0 (58.0–77.0) years, and 521 patients (87.9%) presented with congestion. Congestive patients had higher rates of previous cardiac disease (60.5% vs. 43.1%; P < 0.01) and chronic kidney disease (24.2% vs. 12.5%; P = 0.04). No differences were found regarding Society for Cardiovascular Angiography and Interventions class distribution and lactate concentrations. Congestion was associated with an increased 30-day all-cause death rate (hazard ratio: 1.99, 95% confidence interval: 1.05–3.78; P = 0.04), particularly among patients with persistent congestion beyond 24 hours (hazard ratio: 2.29, 95% confidence interval: 1.20–4.36; P = 0.01). Conversely, patients with resolved congestion at 24 hours had similar outcomes to non-congestive patients (hazard ratio: 0.76, confidence interval: 0.31–1.88; P = 0.56). The negative impact of congestion was confirmed in multivariable Cox regression analysis.
Conclusions |
Congestion and its persistence beyond 24 hours of management are frequent in patients with cardiogenic shock, and are significantly associated with an increased 30-day all-cause death rate, which may reflect either a direct harmful effect of congestion or difficulties in achieving decongestion in sicker patients. Further studies are warranted to clarify optimal decongestion strategies in patients with cardiogenic shock.
Le texte complet de cet article est disponible en PDF.Keywords : Cardiogenic shock, Congestion, Prognosis, Death
Plan
Vol 119 - N° 3
P. 201-209 - mars 2026 Retour au numéro
Article précédent
- Optimizing oral low-density lipoprotein cholesterol-lowering therapy in statin-intolerant patients: A simulation study in France
- Francois Schiele, Michel Farnier, Bénédicte Borsik
- Snare catheter technique in complex transcatheter aortic valve implantation procedures
- Anthony Mezier, Nicolas Combaret, Andrea Innorta, Nicolas d’Ostrevy, Christophe Saint Etienne, Geraud Souteyrand
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?