TY - JOUR
T1 - Early Utilization of Mechanical Circulatory Support in Acute Myocardial Infarction Complicated by Cardiogenic Shock
T2 - The National Cardiogenic Shock Initiative
AU - Basir, Mir B.
AU - Lemor, Alejandro
AU - Gorgis, Sarah
AU - Patel, Kirit C.
AU - Kolski, Brian C.
AU - Bharadwaj, Aditya S.
AU - Todd, Joshua W.
AU - Tehrani, Behnam N.
AU - Truesdell, Alexander G.
AU - Lasorda, David M.
AU - Lalonde, Thomas A.
AU - Kaki, Amir
AU - Schrieber, Theodore L.
AU - Patel, Nainesh C.
AU - Senter, Shaun R.
AU - Gelormini, Joseph L.
AU - Marso, Steven P.
AU - Rahman, Ayaz M.
AU - Federici, Robert E.
AU - Wilkins, Charles E.
AU - McRae, A. Thomas
AU - Nsair, Ali
AU - Caputo, Christopher P.
AU - Khuddus, Matheen A.
AU - Chahin, Juan J.
AU - Dupont, Allison G.
AU - Goldsweig, Andrew M.
AU - Lim, Michael J.
AU - Kapur, Navin K.
AU - Wohns, David H.W.
AU - Zhou, Yueren
AU - Hacala, Michael J.
AU - O’neill, William W.
N1 - Publisher Copyright:
© 2023 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2023/12/5
Y1 - 2023/12/5
N2 - BACKGROUND: Acute myocardial infarction complicated by cardiogenic shock (AMI-CS) is associated with significant morbidity and mortality. Mechanical circulatory support (MCS) devices increase systemic blood pressure and end organ perfusion while reducing cardiac filling pressures. METHODS AND RESULTS: The National Cardiogenic Shock Initiative (NCT03677180) is a single-arm, multicenter study. The purpose of this study was to assess the feasibility and effectiveness of utilizing early MCS with Impella in patients presenting with AMI-CS. The primary end point was in-hospital mortality. A total of 406 patients were enrolled at 80 sites between 2016 and 2020. Average age was 64±12 years, 24% were female, 17% had a witnessed out-of-hospital cardiac arrest, 27% had in-hospital cardiac arrest, and 9% were under active cardiopulmonary resuscitation during MCS implantation. Patients presented with a mean systolic blood pressure of 77.2±19.2 mm Hg, 85% of patients were on vasopressors or inotropes, mean lactate was 4.8±3.9 mmol/L and cardiac power output was 0.67±0.29 watts. At 24 hours, mean systolic blood pressure improved to 103.9±17.8 mm Hg, lactate to 2.7±2.8 mmol/L, and cardiac power output to 1.0±1.3 watts. Procedural survival, survival to discharge, survival to 30 days, and survival to 1 year were 99%, 71%, 68%, and 53%, respectively. CONCLUSIONS: Early use of MCS in AMI-CS is feasible across varying health care settings and resulted in improvements to early hemodynamics and perfusion. Survival rates to hospital discharge were high. Given the encouraging results from our analysis, randomized clinical trials are warranted to assess the role of utilizing early MCS, using a standardized, multidisciplinary approach.
AB - BACKGROUND: Acute myocardial infarction complicated by cardiogenic shock (AMI-CS) is associated with significant morbidity and mortality. Mechanical circulatory support (MCS) devices increase systemic blood pressure and end organ perfusion while reducing cardiac filling pressures. METHODS AND RESULTS: The National Cardiogenic Shock Initiative (NCT03677180) is a single-arm, multicenter study. The purpose of this study was to assess the feasibility and effectiveness of utilizing early MCS with Impella in patients presenting with AMI-CS. The primary end point was in-hospital mortality. A total of 406 patients were enrolled at 80 sites between 2016 and 2020. Average age was 64±12 years, 24% were female, 17% had a witnessed out-of-hospital cardiac arrest, 27% had in-hospital cardiac arrest, and 9% were under active cardiopulmonary resuscitation during MCS implantation. Patients presented with a mean systolic blood pressure of 77.2±19.2 mm Hg, 85% of patients were on vasopressors or inotropes, mean lactate was 4.8±3.9 mmol/L and cardiac power output was 0.67±0.29 watts. At 24 hours, mean systolic blood pressure improved to 103.9±17.8 mm Hg, lactate to 2.7±2.8 mmol/L, and cardiac power output to 1.0±1.3 watts. Procedural survival, survival to discharge, survival to 30 days, and survival to 1 year were 99%, 71%, 68%, and 53%, respectively. CONCLUSIONS: Early use of MCS in AMI-CS is feasible across varying health care settings and resulted in improvements to early hemodynamics and perfusion. Survival rates to hospital discharge were high. Given the encouraging results from our analysis, randomized clinical trials are warranted to assess the role of utilizing early MCS, using a standardized, multidisciplinary approach.
KW - Impella
KW - acute myocardial infarction
KW - cardiogenic shock
KW - mechanical circulatory support
KW - percutaneous coronary intervention
KW - pulmonary artery catheter
UR - http://www.scopus.com/inward/record.url?scp=85179005371&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85179005371&partnerID=8YFLogxK
U2 - 10.1161/JAHA.123.031401
DO - 10.1161/JAHA.123.031401
M3 - Article
C2 - 38014676
AN - SCOPUS:85179005371
SN - 2047-9980
VL - 12
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 23
M1 - e031401
ER -