What is the duration of survival in cardiogenic shock?

Duration of Survival in Cardiogenic Shock

Without early revascularization, cardiogenic shock carries a 30-day mortality of approximately 60-65%, but with emergency revascularization, approximately 50% of patients survive to 30 days, 47% survive to 1 year, and 33% survive to 6 years. 1, 2

Short-Term Survival (30 Days)

• In-hospital mortality remains 40-50% even with optimal contemporary management including early revascularization 3
• Patients receiving only medical therapy have 30-day mortality rates of 56-63%, compared to 44-47% with emergency revascularization 4, 2
• The absolute survival benefit of early revascularization is approximately 13% at 30 days, though this difference becomes statistically significant only at 6 months 1, 4

Intermediate-Term Survival (6-12 Months)

• At 6 months, 50% of patients treated with early revascularization are alive compared to 37% with initial medical stabilization 4
• One-year survival is 46.7% with early revascularization versus 33.6% with medical therapy alone 2
• Among hospital survivors, 1-year survival improves substantially: 62.4% in the early revascularization group versus 44.4% in the medical stabilization group 1

Long-Term Survival (Beyond 1 Year)

• At 6 years, overall survival is 32.8% for early revascularization versus 19.6% for initial medical stabilization—a persistent 13.2% absolute survival advantage 1
• Among hospital survivors who make it to 1 year, annualized death rates are 8.0% for revascularization patients versus 10.7% for medical therapy patients 1
• The survival benefit of early revascularization remains stable from 1 year through 6 years of follow-up 1

Critical Time Windows for Intervention

Emergency revascularization should be performed within 18 hours of shock onset for patients presenting within 36 hours of myocardial infarction 5

• The ACC/AHA guidelines specify a Class I recommendation for patients <75 years old when revascularization can be achieved within this window 5, 6
• For every 10-minute delay in primary PCI after 60 minutes from first medical contact, there are an additional 3-4 deaths per 100 patients, with >80% mortality beyond 6 hours of delay in cardiogenic shock 5
• Median time from randomization to revascularization in the SHOCK trial was 0.9 hours for PCI and 2.7 hours for CABG 6

Age-Specific Considerations

Patients <75 years old derive the greatest benefit from early revascularization, with 20 lives saved per 100 patients treated at 6 months 4

• Among patients ≥75 years, survival to hospital discharge is 56%, and of these survivors, 75% are alive at 1 year when early revascularization is performed 5
• The treatment benefit is apparent primarily in younger patients, though selected elderly patients with good functional status may still benefit 5

Functional Status of Survivors

• Among 1-year survivors, 83% are in NYHA functional class I or II, indicating good quality of life 2
• This applies to 85% of the early revascularization group and 80% of the initial medical stabilization group who survive to 1 year 2

Common Pitfalls

• Do not delay revascularization beyond 18 hours of shock onset, as mortality increases dramatically with each hour of delay 5
• Avoid assuming elderly patients cannot benefit—while age >75 years reduces treatment effect, selected patients with good baseline function should still receive aggressive therapy 5
• Do not rely on mechanical circulatory support devices (IABP, VA-ECMO) as primary therapy—these do not improve survival and should only serve as bridges to definitive revascularization 5, 6