Myocarditis-Associated Cardiogenic Shock: A Nationwide Multicenter Study

BACKGROUND: There are limited data on the management of myocarditis-associated cardiogenic shock. The aim of this study was to assess the clinical outcomes of patients with myocarditis-associated cardiogenic shock. METHODS: In this retrospective study using the Vizient Clinical Data Base, patients aged ≥18 years admitted with cardiogenic shock during 2015 through 2023 across the United States were stratified by myocarditis status. We assessed in-hospital death by augmented inverse probability weighting, accounting for demographics, comorbidities, critical care therapies, and hospital characteristics. RESULTS: A total of 621 695 patients with cardiogenic shock were included. Patients with myocarditis (n=2925; 0.5%) were younger (49.9 versus 65.2 years), more likely to be women (45.9% versus 36.7%), and had a lower Charlson comorbidity index (3.6 versus 4.4) but higher rates of cancer (13.5% versus 7.5%) and rheumatic disease (8.3% versus 3.4%) (all P<;0.001). They required more inotropic medications (56.9% versus 41.3%) and mechanical circulatory support (35.2% versus 19.3%) and more invasive procedures such as left ventricular assist device implantation (4.5% versus 2.3%) and heart transplantation (5.0% versus 1.8%), left heart catheterization (33.1% versus 26.0%), and pulmonary artery catheterization (49.5% versus 26.3%), but fewer percutaneous coronary interventions (2.0% versus 12.1%) or coronary artery bypass grafting (0.8% versus 7.5%) (all P<;0.001). Following augmented inverse probability weighting, myocarditis was associated with a higher adjusted mortality rate (+9.8% [95% CI, 4.0–15.5]; P=0.001). CONCLUSIONS: Myocarditis-associated cardiogenic shock is uncommon yet represents a critically ill population with a higher adjusted in-hospital mortality rate. Future work investigating therapies for this unique patient population is warranted.