Major bleeding and mortality in cardiogenic shock: insights from the SMART-RESCUE II shock registry
J J Kim, M C Kim, M S Kim, H C Gwon, J H Yang, I H Park, B H Hwang, K ChangAbstract
Background
Major bleeding represents a frequent and clinically relevant complication in cardiogenic shock, particularly in the setting of intensified antithrombotic regimens and advanced hemodynamic support strategies. Despite this, the prognostic relevance of bleeding in modern cardiogenic shock cohorts remains insufficiently delineated.
Methods
SMART-RESCUE II is a prospective multicenter registry including 1,359 patients with cardiogenic shock enrolled between October 2019 and August 2025. Major bleeding events during the index hospitalization were systematically recorded. The primary endpoint was 12-month all-cause and cardiac mortality. Survival was assessed by Kaplan–Meier analysis according to bleeding status. Multivariable regression was used to determine the independent association between major bleeding and 12-month mortality after adjustment for relevant clinical covariates.
Results
Major bleeding occurred in 151 patients (11.1%). Twelve-month all-cause and cardiac mortality were significantly higher in patients with major bleeding compared with those without (55.0% vs. 25.7% and 38.4% vs. 18.8%, respectively). Survival curves separated early and remained apart throughout follow-up. In the adjusted model, major bleeding was independently associated with 12-month all-cause mortality (adjusted odds ratio 1.74; 95% confidence interval 1.31–2.31; p<0.001) and cardiac death (adjusted odds ratio 1.46; 95% confidence interval 1.03–2.08; p=0.035), along with older age, male sex, higher creatinine and lactate levels, and lower LVEF.
Conclusion
Major bleeding was independently associated with higher 12-month mortality in patients with cardiogenic shock, underscoring its prognostic relevance and the need to mitigate bleeding risk in this population.For image description, please refer to the figure legend and surrounding text.