Association between mean arterial pressure during the first 24 hours and hospital mortality in patients with cardiogenic shock.

Background: The optimal MAP target for patients with cardiogenic shock (CS) remains unknown. We sought to determine the relationship between mean arterial pressure (MAP) and mortality in the cardiac intensive care unit (CICU) patients with CS.

Methods: Using a single-center database of CICU patients admitted between 2007 and 2015, we identified patients with an admission diagnosis of CS. MAP was measured every 15 min, and the mean of all MAP values during the first 24 h (mMAP) was recorded. Multivariable logistic regression determined the relationship between mMAP and adjusted hospital mortality.

Results: We included 1002 patients with a mean age of 68 ± 13.7 years, including 36% females. Admission diagnoses included acute coronary syndrome in 60%, heart failure in 74%, and cardiac arrest in 38%. Vasoactive drugs were used in 72%. The mMAP was higher (75 vs. 71 mmHg, p < 0.001) among hospital survivors (66%) compared with non-survivors (34%). Hospital mortality was inversely associated with mMAP (adjusted OR 0.9 per 5 mmHg higher mMAP, p = 0.01), with a stepwise increase in hospital mortality at lower mMAP. Patients with mMAP < 65 mmHg were at higher risk of hospital mortality (57% vs. 28%, adjusted OR 2.0, 95% CI 1.4-3.0, p < 0.001); no differences were observed between patients with mMAP 65-74 vs. ≥ 75 mmHg (p > 0.1).

Conclusion: In patients with CS, we observed an inverse relationship between mMAP and hospital mortality. The poor outcomes in patients with mMAP < 65 mmHg provide indirect evidence supporting a MAP goal of 65 mmHg for patients with CS.