BACKGROUND: There are limited large-scale data on the outcomes of patients with cardiogenic shock (CS) transferred to hub centers. This study aimed to compare the characteristics and outcomes of transferred patients with CS versus those who were not transferred. METHODS: Adults (aged ≥18 years) with a primary or secondary diagnosis of CS were identified from the Nationwide Readmissions Database (2016–2020) and stratified by transfer status. Overlap propensity score weighting was performed to assess the association between transfer status and in-hospital mortality. Secondary outcomes, including length of hospital stay, hospitalization costs, and readmissions for cardiac and noncardiac etiologies, were assessed using multivariable regression. RESULTS: Of 314 098 patients with CS (27% with acute myocardial infarction-related CS and 73% with nonacute myocardial infarction-related CS), 30 630 (9.8%) were transferred. In the unweighted population, compared with nontransferred patients, transferred patients were on average younger (65 versus 68 years), had higher comorbidities, and were more likely to be cared for at large teaching hospitals. During the hospitalization, they had higher rates of renal failure, pulmonary artery catheter use, and mechanical circulatory support use. In-hospital mortality was lower in transferred patients—39.1% versus 47.1%; unadjusted odds ratio (OR), 0.71 (95% CI, 0.70–0.73); adjusted OR, 0.73 ([95% CI, 0.71–0.76]; P <0.001). This was consistent across subgroups of CS cause, age, sex, hospital location, mechanical circulatory support use, and presence of cardiac arrest. The transferred cohort had lower costs and length of stay, but more frequent all-cause (adjusted OR, 1.21 [95% CI, 1.16–1.27]), cardiac (adjusted OR, 1.16 [95% CI, 1.11–1.22]), heart failure (adjusted OR, 1.14 [95% CI, 1.08–1.21]), and noncardiac readmissions (adjusted OR, 1.68 [95% CI, 1.21–2.33]) at 30 days postdischarge compared with the nontransferred cohort. CONCLUSIONS: Despite higher comorbidity, organ failure, and use of cardiac/noncardiac procedures, patients with CS who were transferred to hub centers had lower in-hospital mortality, hospitalization costs, and length of stay.

Background: Self‐expanding valves (SEVs) have demonstrated superior hemodynamic performance and comparable clinical outcomes to balloon‐expandable valves (BEVs) at 1 year in patients with a small aortic annulus. However, long‐term data are limited. This study aimed to evaluate 5‐year echocardiographic and clinical outcomes of SEVs versus BEVs in patients with small aortic annulus underwent transcatheter aortic valve replacement. Methods: We analyzed RESOLVE registry patients who underwent transcatheter aortic valve replacement at Cedars‐Sinai between 2015 and 2020. Patients with a small aortic annulus (<430 mm ² by computed tomography) were included and followed for up to 5 years. The primary outcome was a composite of all‐cause mortality, stroke, or heart failure hospitalization. Secondary outcomes included myocardial infarction, pacemaker implantation, aortic valve reintervention, and structural bioprosthetic valve dysfunction. Results: Among 1392 transcatheter aortic valve replacement recipients, 423 (78 SEVs, 345 BEVs) met the small annulus criteria. SEVs were associated with lower transvalvular gradients and larger indexed effective orifice area at discharge and 1 year ( P <0.001). Moderate‐to‐severe paravalvular leak was more frequent with SEVs at 30 days (7.7% versus 1.5%, P <0.001), as was permanent pacemaker implantation (17.9% versus 6.1%, P <0.001). At 5 years, the primary outcome did not differ significantly (hazard ratio, 1.21; 95% CI, 0.81–1.82; P <0.33). All‐cause mortality, stroke, heart failure hospitalization, structural bioprosthetic valve dysfunction, and reintervention rates were similar between groups. Conclusion: Although SEVs provide better hemodynamic performance in patients with severe aortic stenosis and small annuli, this advantage did not translate into improved survival or reduced cardiovascular events at 5 years.