Comparative analysis of the DanGer shock trial to randomized cardiogenic shock trials and real-world registries.

Abstract

Background: The Danish-German Cardiogenic (DanGer) Shock Trial reported lower mortality with a percutaneous micro-axial flow pump compared to standard care in patients with STEMI-related cardiogenic shock. It remains unclear how the DanGer Shock trial population compares to randomized controlled trials (RCTs) and real-world registries studying temporary mechanical circulatory support (tMCS) for acute myocardial infarction with cardiogenic shock (AMICS).

Methods: A systematic review and meta-analysis of RCTs and registries involving tMCS for AMICS was performed. Patient characteristics and outcomes were compared to those in the DanGer Shock Trial.

Results: From 2005 to 2023, seven RCTs (1201 patients) and ten registries (2100 patients) were analyzed. DanGer Shock patients had fewer comorbidities, lower blood pressure, lower Left ventricular ejection fraction (LVEF), higher heart rates, and shorter times to tMCS initiation (5.5 ± 2.7 vs. 19.1 ± 38.3 h, p < 0.0001) than RCT patients. They required shorter tMCS durations, less mechanical ventilation, and inotropic support. DanGer patients experienced fewer bleeding events, infections, and limb ischemia, with similar 30-day mortality but higher stroke rates. Compared to registry patients, DanGer Shock patients had fewer comorbidities but required longer tMCS, more mechanical ventilation, and inotropic support, with fewer complications and lower 30-day mortality.

Conclusion: DanGer Shock patients had better survival despite worse initial hemodynamics, possibly due to fewer comorbidities, earlier tMCS initiation, and an algorithmic treatment approach.