{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T19:48:10Z","timestamp":1778701690962,"version":"3.51.4"},"reference-count":32,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2024,4,3]],"date-time":"2024-04-03T00:00:00Z","timestamp":1712102400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The management of cardiogenic shock (CS) after ACS has evolved over time, and the development of a multidisciplinary team-based approach has been shown to improve outcomes, although mortality remains high. Methods: All consecutive patients with ACS-CS admitted at our CICU from March 2012 to July 2021 were included in this single-center retrospective study. In 2019, we established a \u201cshock team\u201d consisting of a cardiac intensivist, an interventional cardiologist, an anesthetist, and a cardiac surgeon. The primary outcome was in-hospital mortality. Results: We included 167 patients [males 67%; age 71 (61\u201380) years] with ischemic CS. The proportion of SCAI shock stages from A to E were 3.6%, 6.6%, 69.4%, 9.6%, and 10.8%, respectively, with a mean baseline serum lactate of 5.2 (3.1\u20138.8) mmol\/L. Sixty-six percent of patients had severe LV dysfunction, and 76.1% needed \u2265 1 inotropic drug. Mechanical cardiac support (MCS) was pursued in 91.1% [65% IABP, 23% Impella CP, 4% VA-ECMO]. From March 2012 to July 2021, we observed a significative temporal trend in mortality reduction from 57% to 29% (OR = 0.90, p = 0.0015). Over time, CS management has changed, with a significant increase in Impella catheter use (p = 0.0005) and a greater use of dobutamine and levosimendan (p = 0.015 and p = 0.0001) as inotropic support. In-hospital mortality varied across SCAI shock stages, and the SCAI E profile was associated with a poor prognosis regardless of patient age (OR 28.50, p = 0.039). Conclusions: The temporal trend mortality reduction in CS patients is multifactorial, and it could be explained by the multidisciplinary care developed over the years.<\/jats:p>","DOI":"10.3390\/jcm13072101","type":"journal-article","created":{"date-parts":[[2024,4,4]],"date-time":"2024-04-04T00:42:26Z","timestamp":1712191346000},"page":"2101","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Evolution of Cardiogenic Shock Management and Development of a Multidisciplinary Team-Based Approach: Ten Years Experience of a Single Center"],"prefix":"10.3390","volume":"13","author":[{"given":"Leonardo","family":"Belfioretti","sequence":"first","affiliation":[{"name":"Intensive Care Unit, Cardiology Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7798-1351","authenticated-orcid":false,"given":"Matteo","family":"Francioni","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Cardiology Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ilaria","family":"Battistoni","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Cardiology Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luca","family":"Angelini","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Cardiology Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2443-5370","authenticated-orcid":false,"given":"Maria Vittoria","family":"Matassini","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Cardiology Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia","family":"Pongetti","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Cardiology Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matilda","family":"Shkoza","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Cardiology Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luca","family":"Piangerelli","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Cardiology Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tommaso","family":"Piva","sequence":"additional","affiliation":[{"name":"Intervention Cardiology, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2055-5516","authenticated-orcid":false,"given":"Elisa","family":"Nicolini","sequence":"additional","affiliation":[{"name":"Intervention Cardiology, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Maolo","sequence":"additional","affiliation":[{"name":"Intervention Cardiology, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andi","family":"Mu\u00e7aj","sequence":"additional","affiliation":[{"name":"Intervention Cardiology, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1924-6548","authenticated-orcid":false,"given":"Paolo","family":"Compagnucci","sequence":"additional","affiliation":[{"name":"Cardiology and Arrhythmology Clinic, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Munch","sequence":"additional","affiliation":[{"name":"Cardiac Anaesthesia and Intensive Care Unit, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Dello Russo","sequence":"additional","affiliation":[{"name":"Cardiology and Arrhythmology Clinic, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Di Eusanio","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2165-556X","authenticated-orcid":false,"given":"Marco","family":"Marini","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Cardiology Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,4,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1002\/ejhf.1922","article-title":"Epidemiology, pathophysiology and contemporary management of cardiogenic shock\u2014A position statement from the Heart Failure Association of the European Society of Cardiology","volume":"22","author":"Chioncel","year":"2020","journal-title":"Eur. J. Heart Fail."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"101316","DOI":"10.1016\/j.tacc.2023.101316","article-title":"Prediction of fluid responsiveness in critical care: Current evidence and future perspective","volume":"54","author":"Vasile","year":"2024","journal-title":"Trends Anaesth. Crit. Care"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1186\/s13613-022-01022-8","article-title":"Prediction of fluid responsiveness. What\u2019s new?","volume":"12","author":"Monnet","year":"2022","journal-title":"Ann. Intensive Care"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"C276","DOI":"10.1093\/eurheartjsupp\/suad027","article-title":"Acute heart failure: Differential diagnosis and treatment","volume":"25","author":"Marini","year":"2023","journal-title":"Eur. Heart J. Suppl."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1007\/s00134-018-5214-9","article-title":"Management of cardiogenic shock complicating myocardial infarction","volume":"44","author":"Mebazaa","year":"2018","journal-title":"Intensive Care Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3523","DOI":"10.1093\/eurheartj\/ehx363","article-title":"Percutaneous short-term active mechanical support devices in cardiogenic shock: A systematic review and collaborative meta-analysis of randomized trials","volume":"38","author":"Thiele","year":"2017","journal-title":"Eur. Heart J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1161\/CIRCULATIONAHA.118.038201","article-title":"Intraaortic Balloon Pump in Cardiogenic Shock Complicating Acute Myocardial Infarction: Long-Term 6-Year Outcome of the Randomized IABP-SHOCK II Trial","volume":"139","author":"Thiele","year":"2018","journal-title":"Circulation"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1016\/j.jacc.2022.01.018","article-title":"SCAI SHOCK Stage Classification Expert Consensus Update: A Review and Incorporation of Validation Studies: This statement was endorsed by the American College of Cardiology (ACC), American College of Emergency Physicians (ACEP), American Heart Association (AHA), European Society of Cardiology (ESC) Association for Acute Cardiovascular Care (ACVC), International Society for Heart and Lung Transplantation (ISHLT), Society of Critical Care Medicine (SCCM), and Society of Thoracic Surgeons (STS) in December 2021","volume":"79","author":"Naidu","year":"2022","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2117","DOI":"10.1016\/j.jacc.2019.07.077","article-title":"Cardiogenic Shock Classification to Predict Mortality in the Cardiac Intensive Care Unit","volume":"74","author":"Jentzer","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2511","DOI":"10.1001\/jama.295.21.2511","article-title":"Early revascularization and long-term survival in cardiogenic shock complicating acute myocardial infarction","volume":"295","author":"Hochman","year":"2006","journal-title":"JAMA"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1161\/CIRCULATIONAHA.119.040654","article-title":"Shock Team Approach in Refractory Cardiogenic Shock Requiring Short-Term Mechanical Circulatory Support: A Proof of Concept","volume":"140","author":"Taleb","year":"2019","journal-title":"Circulation"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1002\/ccd.28307","article-title":"Improved Outcomes Associated with the use of Shock Protocols: Updates from the National Cardiogenic Shock Initiative","volume":"93","author":"Basir","year":"2019","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e618","DOI":"10.1161\/CIR.0000000000000617","article-title":"Fourth Universal Definition of Myocardial Infarction (2018)","volume":"138","author":"Thygesen","year":"2018","journal-title":"Circulation"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e15","DOI":"10.1053\/j.jvca.2012.11.009","article-title":"The vasoactive-inotropic score and levosimendan: Time for LVIS?","volume":"27","author":"Favia","year":"2013","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1002\/ejhf.260","article-title":"Clinical picture and risk prediction of short-term mortality in cardiogenic shock","volume":"17","author":"Harjola","year":"2015","journal-title":"Eur. J. Heart Fail."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1208","DOI":"10.1093\/eurjhf\/hfs117","article-title":"Acute heart failure patient profiles, management and in-hospital outcome: Results of the Italian Registry on Heart Failure Outcome","volume":"14","author":"Oliva","year":"2012","journal-title":"Eur. J. Heart Fail."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1007\/s00392-017-1182-2","article-title":"Trends in mechanical circulatory support use and hospital mortality among patients with acute myocardial infarction and non-infarction related cardiogenic shock in the United States","volume":"107","author":"Shah","year":"2018","journal-title":"Clin. Res. Cardiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"688098","DOI":"10.3389\/fcvm.2021.688098","article-title":"Impact of Age on Outcomes in Patients with Cardiogenic Shock","volume":"8","author":"Kanwar","year":"2021","journal-title":"Front. Cardiovasc. Med."},{"key":"ref_19","first-page":"392","article-title":"Evolution of STEMI network in Italy","volume":"66","author":"Saia","year":"2018","journal-title":"Minerva Cardioangiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.1056\/NEJMoa1208410","article-title":"Intraaortic balloon support for myocardial infarction with cardiogenic shock","volume":"367","author":"Thiele","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Heart J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"C204","DOI":"10.1093\/eurheartj\/suab074","article-title":"ANMCO POSITION PAPER: Role of intra-aortic balloon pump in patients with acute advanced heart failure and cardiogenic shock","volume":"23","author":"Rossini","year":"2021","journal-title":"Eur. Heart J. Suppl."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1254","DOI":"10.1161\/CIRCULATIONAHA.121.058229","article-title":"Percutaneous Transvalvular Microaxial Flow Pump Support in Cardiology","volume":"145","author":"Kellnar","year":"2022","journal-title":"Circulation"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1002\/ccd.30484","article-title":"SCAI stage reclassification at 24 h predicts outcome of cardiogenic shock: Insights from the Altshock-2 registry","volume":"101","author":"Morici","year":"2023","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"737","DOI":"10.12688\/f1000research.11150.1","article-title":"Acute mechanical circulatory support for cardiogenic shock: The \u201cdoor to support\u201d time","volume":"6","author":"Esposito","year":"2017","journal-title":"F1000Research"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.jacc.2022.04.049","article-title":"Criteria for Defining Stages of Cardiogenic Shock Severity","volume":"80","author":"Kapur","year":"2022","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1249","DOI":"10.1161\/CIRCULATIONAHA.118.036614","article-title":"Impella Support for Acute Myocardial Infarction Complicated by Cardiogenic Shock","volume":"139","author":"Schrage","year":"2019","journal-title":"Circulation"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1016\/j.jacc.2016.10.022","article-title":"Percutaneous Mechanical Circulatory Support Versus Intra-Aortic Balloon Pump in Cardiogenic Shock After Acute Myocardial Infarction","volume":"69","author":"Ouweneel","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1016\/j.amjcard.2016.11.037","article-title":"Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock","volume":"119","author":"Basir","year":"2017","journal-title":"Am. J. Cardiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/joic.12080","article-title":"The current use of Impella 2.5 in acute myocardial infarction complicated by cardiogenic shock: Results from the USpella Registry","volume":"27","author":"Schreiber","year":"2014","journal-title":"J. Interv. Cardiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1002\/ehf2.13180","article-title":"Cardiogenic shock teams and centres: A contemporary review of multidisciplinary care for cardiogenic shock","volume":"8","author":"Moghaddam","year":"2021","journal-title":"ESC Heart Fail."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1171956","DOI":"10.3389\/fcvm.2023.1171956","article-title":"Clinical outcomes and predictors of success with Impella weaning in cardiogenic shock: A single-center experience","volume":"10","author":"Matassini","year":"2023","journal-title":"Front. Cardiovasc. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/7\/2101\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:23:12Z","timestamp":1760106192000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/7\/2101"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,3]]},"references-count":32,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2024,4]]}},"alternative-id":["jcm13072101"],"URL":"https:\/\/doi.org\/10.3390\/jcm13072101","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,3]]}}}