Mechanical circulatory support protocol beneficial in acute MI, cardiogenic shock
A protocol involving early use of invasive hemodynamics and mechanical circulatory support conferred a survival benefit in patients with acute MI and cardiogenic shock, a speaker reported.
As Healio previously reported, the protocol developed by the National Cardiogenic Shock Initiative improved in-hospital mortality rates in patients with acute MI and cardiogenic shock from the typical rate of approximately 50%. Babar Basir, DO, FSCAI, director of the acute mechanical circulatory support program and the STEMI program at Henry Ford Hospital in Detroit, presented the final results from the study at the virtual Society for Cardiovascular Angiography and Interventions Scientific Sessions.
The protocol includes beginning hemodynamic support before escalating inotropes, using right heart catheterization to determine heart function, implanting the hemodynamic support device (Impella family of products, Abiomed) before PCI, striving for door-to-support times of less than 90 minutes and mitigating device-related complications, Basir told Healio in a 2019 interview.
The analysis included 406 patients from 80 sites (mean age, 64 years; 24% women; 67% with shock at admission) with acute MI and cardiogenic shock treated from July 2016 to November 2020.
“This was one of the sickest cohorts of cardiogenic shock patients that has ever been studied in a large major trial of cardiogenic shock, including 25% of patients who were in class E shock,” Basir said at a press conference, noting patients with class E shock may be experiencing cardiac arrest with ongoing CPR.
In the full cohort, procedural survival was 99%, survival to discharge was 71%, 30-day survival was 68% and 1-year survival was 53%, Basir said. Compared with patients with class C or D shock, patients with class E shock had lower rates of survival to discharge (54% vs. 79%), 30-day survival (49% vs. 77%) and 1-year survival (31% vs. 62%; P for all < .001).
“Despite the sick cohort, we had a higher survival rate than any previously published study,” Basir said during the press conference.
He said 30-day survival rates were 44% in the medical therapy arm of the SHOCK trial, 53% in the revascularization arm of the SHOCK trial, 57% in the CULPRIT SHOCK trial and 60% in the intra-aortic balloon pump arm of the IABP SHOCK trial. He noted the patients with class C or D shock, who had a 77% 30-day survival rate in the present study, are similar to those who were included in the previous randomized trials.
“It’s a breath of fresh air to see some movement in a positive direction in treating a disease where we’ve had stagnating mortality for the past 20 years,” Basir said during the press conference. “We hypothesize that as adoption of the National Cardiogenic Shock Initiative protocol goes through refinement, as we gain more information on how to support the right ventricle, this will lead to consistent survival rates of over 80%.”
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Basir MB, et al. Featured Clinical Research: Acute coronary and cardiogenic shock. Presented at: Society for Cardiovascular Angiography and Interventions Scientific Sessions; April 28-May 1, 2021 (virtual meeting).