Low admission organ perfusion pressure (OPP) was independently associated with higher in-hospital mortality in patients with cardiogenic shock (CS), according to a retrospective multicentre international registry analysis published in the American Heart Journal. In 621 patients with heart failure-related or acute myocardial infarction-related CS, admission OPP remained prognostic after adjustment for illness severity and hemodynamic variables.

Consecutive patients admitted with CS between July 2023 and October 2024 were included. OPP was calculated at admission as mean arterial pressure minus central venous pressure. The primary endpoint was in-hospital all-cause death.

A total of 621 patients were analyzed, with a mean age of 62 ± 13 years, and 22.2% were female. Most patients (83.4%) presented with Society for Cardiovascular Angiography and Interventions (SCAI) stage ≥C severity. In-hospital mortality occurred in 39.8% (n=247).

Non-survivors had significantly lower admission OPP than survivors (59 mmHg [interquartile range (IQR) 49–69] vs 70 mmHg [IQR 60–80]; p<0.001). In univariable analysis, OPP <57 mmHg was associated with higher mortality (odds ratio [OR] 3.20; 95% confidence interval [CI] 2.25–4.56; p<0.001), consistent across HF-CS and AMI-CS cohorts.

Multivariable analysis confirmed that lower OPP remained independently associated with mortality (OR 1.03 per mmHg decrease; 95% CI 1.01–1.06; p=0.020). OPP showed moderate discrimination for in-hospital mortality, with a C-index of 0.691.

Lower admission OPP was independently associated with higher in-hospital mortality in CS across underlying etiologies and may help risk stratification at presentation.