Clinical Outcomes in Peripartum Cardiomyopathy Complicated by Cardiogenic Shock: A Retrospective Multicenter Cohort Study.

Peripartum cardiomyopathy (PPCM) is a rare but life-threatening condition that occurs in late pregnancy or early postpartum and leads to heart failure with reduced left ventricular ejection fraction (LVEF). A severe complication of PPCM is cardiogenic shock, and its incidence has increased in the recent years. We conducted a retrospective multicenter cohort analysis to evaluate the 180-day clinical outcomes of PPCM complicated by cardiogenic shock (PPCM-CS), with a focus on the role of mechanical circulatory support. We identified 733 patients diagnosed with PPCM-CS between January 2010 and January 2024 using TriNetX, a multi-institutional U.S. health record database. Subgroup analysis evaluated outcomes among patients with no mechanical circulatory support (MCS), those managed with intra-aortic balloon pump (IABP) or percutaneous left ventricular assist device (pLVAD), and those supported with extracorporeal membrane oxygenation (ECMO). At 180-day follow-up, all-cause mortality of overall cohort was 15.8%, with higher mortality observed in ECMO (24.1%) and IABP/pLVAD (18.7%) groups. Durable LVAD implantation occurred in 15.0% of the overall cohort, with higher prevalence in ECMO (17.7%) and IABP/pLVAD (29.0%) groups. Heart transplantation was performed in 12.9% of the overall cohort, with higher prevalence in ECMO (19.0%) and IABP/pLVAD (27.1%) patients. Data on outcomes in patients with PPCM complicated by cardiogenic shock remain limited. This study offers insight into the 180-day outcomes in this high-risk population and suggests that, although MCS is associated with higher mortality, it may serve as a viable bridge to advanced therapies.