Early Use of Mechanical Circulatory Support, Invasive Haemodynamics Improve Outcomes for Patients in Cardiogenic Shock
By Eric Ramos
VIRTUAL -- April 29, 2021 -- Early use of mechanical circulatory support and invasive haemodynamics are associated with improved outcomes for patients presenting with acute myocardial infarction (MI) and cardiogenic shock, according to final results from the National Cardiogenic Shock Initiative, presented at the 2021 Virtual Scientific Sessions of the Society for Cardiovascular Angiography and Interventions (SCAI).
“Cardiogenic shock is the leading cause of death in heart attack patients and outcomes have not improved over the past two decades,” said Mir Babar Basir, MD, Henry Ford Health System, Detroit, Michigan. “With early use of mechanical circulatory support coupled with haemodynamic monitoring, we have the potential to increase survival to 80%, and save 20,000 life per year in the United States.”
The National Cardiogenic Shock Initiative (NCT03677180) is a single-arm, prospective, multicentre (73 centres) study assessing outcomes associated with early mechanical circulatory support in patients presenting with acute MI and cardiogenic shock treated with percutaneous coronary intervention (PCI) between July 2016 and December 2020. T
A total of 406 patients were enrolled (mean age, 64 ± 12 years; 24% were female), of which 67% were admitted in shock. In accordance with the protocol, 71% of patients had mechanical circulatory support implanted prior to PCI. Of the patients, 17% had a witnessed out-of-hospital cardiac arrest, 27% had in-hospital cardiac arrest, and 9% were under active cardiopulmonary resuscitation during mechanical circulatory support implantation.
Right heart catheterisation was performed in 93% of patients. The median door to support time was 78 minutes, and door to balloon time was 82 minutes. Patients presented with an average blood pressure of 77/50, lactate of 4.8 mmol/dL, and cardiac power output of 0.67W.
For patients presenting in stage C/D shock, the procedural survival rate was 99%, survival to discharge was 79%, survival to 30 days was 77%, and survival to 1 year was 62%. For patients presenting in stage E shock, the respective survival rates were 98%, 49%, 46%, and 32%.
“A randomised control trial evaluating the National Cardiogenic Shock Initiative treatment strategy is warranted,” said Dr. Basir.
[Presentation title: Final Results From the National Cardiogenic Shock Initiative. Abstract FCR-03]