Cardiogenic shock in cancer: differences in use of temporary mechanical circulatory support, invasive hemodynamic assessment and patient outcomes

Cancer is a growing comorbidity in patients with cardiovascular disease, but implications of cancer for treatment and outcomes of cardiogenic shock (CS) are not well described. This study aimed to identify associations of a cancer diagnosis with use of temporary mechanical circulatory support (tMCS) and survival in young adults hospitalized with CS. We identified young adults (age 18–49) with CS in a large, nationwide sample of hospitalizations (years 2016–2020), and stratified cases according to history of cancer. Variables of interest included clinical and hospital characteristics, use of tMCS, and survival. Multivariable logistic regression was performed to evaluate independent associations of cancer with care and outcomes. Out of 99,335 young adults with CS, 2,705 (2.7%) had cancer. Patients with cancer had a lower burden of cardiovascular risk factors and cardiovascular disease at baseline. STEMI accounted for 13% of CS in patients without cancer compared to 4% in those with cancer. Multivariate analysis adjusted for STEMI, hypertension, diabetes, hyperlipidemia, and other cardiovascular risk factors showed that patients with cancer were less likely to receive tMCS (OR = 0.54, 95% CI 0.40–0.72, p < 0.001) and less likely to undergo pulmonary artery catheterization. They were also more likely to receive palliative care referrals, and more likely to die in the hospital (OR = 1.49, 95% CI 1.23–1.80, p < 0.001). Among young adults hospitalized with CS in the United States in recent years, patients with cancer were less likely to receive tMCS and more likely to die in the hospital despite less pre-existing cardiovascular disease and fewer comorbidities.