DanGer Shock-like profile predicts the outcome in ST-elevation myocardial infarction-related cardiogenic shock

Abstract

Aims

The DanGer Shock (DGS) trial demonstrated that the routine use of a microaxial flow pump (mAFP) with standard care to treat STEMI-related cardiogenic shock (STEMI-CS) led to a lower risk of all-cause death at 180 days than standard care alone. We investigated the impact of patient eligibility for DGS in an all-comers cardiogenic shock registry of patients receiving a mAFP.

Methods and results

Prospective single-centre mAFP registry including 478 CS-patients with 225 patients having STEMI-CS. DGS-like was defined as STEMI-CS, lactate ≥2.5 mmol/L, left ventricular ejection fraction < 45%, no mechanical complications, and no comatose out-of-hospital cardiac arrest but in-hospital cardiac arrest with a maximum of 10 min to return of spontaneous circulation as a surrogate for medically witnessed cardiac arrest was included. The comparison group consisted of STEMI-CS patients who did not fulfil the aforementioned criteria (DGS-unlike). The primary outcome was 180-day mortality. Out of 225 STEMI-CS, 64 (28.4%) patients were considered DGS-like. Those patients were younger, had less often received CPR before mAFP implantation, and mAFP-support was longer. Comorbidities, baseline lactate, coronary artery disease characteristics/treatment, inotropes/vasopressors, and escalation to other mechanical circulatory support devices were not different. All-cause mortality at 180 days was significantly lower in the DGS-like compared to the DGS-unlike cohort (62.5% vs. 72.0%, P = 0.014) as was 30-day all-cause mortality (48.4% vs. 70.2%, P < 0.001). DGS-like remained an independent predictor of both 180-day (HR 0.57, 95% CI 0.39, 0.83) and 30-day mortality (HR 0.48, 95% CI 0.32, 0.72) in a multivariable analysis.

Conclusions

A DGS-like profile was associated with a lower 180-day mortality compared with a DGS-unlike profile in a STEMI-CS cohort treated by mAFP.