Microaxial Flow Pump Use in Different Phenotypes of Cardiogenic Shock - a Secondary Analysis of the DanGer Shock Trial.

BACKGROUND: Three cardiogenic shock (CS) phenotypes have been proposed and validated in various datasets: non-congested (I), cardiorenal (II), and cardiometabolic CS (III). The DanGer Shock trial demonstrated a mortality benefit of microaxial flow pump (mAFP) use in myocardial infarction-related CS. In this post-hoc analysis, we aimed to assess trajectories and outcomes of these phenotypes in the DanGer Shock population.

METHODS: Patients randomized in the DanGer Shock trial were retrospectively assigned to one of three CS phenotypes at admission. Missing values for phenotyping were imputed using multiple random forest imputation. Outcomes were 180-day mortality, and trajectories of key clinical, laboratory and hemodynamic parameters first 72 hours within phenotypes, stratified by allocation to mAFP or standard of care.

RESULTS: Out of 355 adult patients in the trial, 145 (41%), 38 (11%), and 172 (48%) patients were in the non-congested, cardiorenal, and cardiometabolic phenotypes, respectively. 180-day mortality was higher in cardiometabolic (69%) compared to non-congested (33%) and cardiorenal CS (47%). Clinical metabolic and hemodynamic trajectories and their treatment response differed between phenotypes. mAFP use was associated with lower mortality in non-congested CS (odds ratio: 0.51 [0.28-0.91], p=0.02). The odds of mortality were 0.81 [0.57-1.16] (p=0.25) in cardiometabolic and 0.91 [0.35-2.34] (p=0.84) in cardiorenal CS (p for interaction: 0.43).

CONCLUSION: In this post-hoc analysis of the DanGer Shock trial, predefined CS phenotypes showed distinct outcomes, with the non-congested phenotype faring best and the cardiometabolic worst. The greatest apparent benefit of mAFP was observed in non-congested CS. These findings are hypothesis-generating and warrant confirmation in prospective studies.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov unique identifier: NCT01633502. Condensed Abstract In this DanGer Shock post-hoc analysis, study participants were retrospectively assigned to one of three cardiogenic shock (CS) phenotypes: non-congested, cardiorenal, or cardiometabolic CS. 41%, 11%, and 48% of all 355 patients were in these phenotypes, respectively. 180-day mortality was higher in cardiometabolic (69%) compared to non-congested (33%) and cardiorenal CS (47%). mAFP use was associated with lower mortality in non-congested and numerically in cardiometabolic, but not in cardiorenal CS. In summary, CS phenotypes showed distinct outcomes, with the non-congested phenotype faring best and the cardiometabolic worst. The greatest apparent benefit of mAFP was observed in non-congested CS.

Copyright © 2026 The Author(s). Published by Elsevier Inc. All rights reserved.

PMID: 41785958