The following is a summary of “Early Utilization of Mechanical Circulatory Support in Acute Myocardial Infarction Complicated by Cardiogenic Shock: The National Cardiogenic Shock Initiative,” published in the November 2023 issue of Cardiology by Basir et al.
Acute myocardial infarction complicated by cardiogenic shock (AMI‐CS) poses substantial risks of morbidity and mortality. Mechanical circulatory support (MCS) devices play a crucial role in enhancing systemic blood pressure, improving organ perfusion, and reducing cardiac filling pressures.
The National Cardiogenic Shock Initiative (NCT03677180) constitutes a multicenter, single‐arm study aiming to evaluate the viability and efficacy of employing early MCS, specifically Impella, in AMI‐CS patients upon presentation. The primary objective was to assess in-hospital mortality. Enrollment of 406 patients across 80 sites occurred between 2016 and 2020. Patients averaged 64±12 years, 24% were female, and notable instances included 17% having witnessed out-of-hospital cardiac arrest, 27% experiencing in-hospital cardiac arrest, and 9% receiving active cardiopulmonary resuscitation during MCS implantation. On arrival, patients had a mean systolic blood pressure of 77.2±19.2 mm Hg, with 85% on vasopressors or inotropes, a mean lactate level of 4.8±3.9 mmol/L, and cardiac power output at 0.67±0.29 watts. Within 24 hours, there were noticeable improvements in systolic blood pressure (103.9±17.8 mm Hg), lactate levels (2.7±2.8 mmol/L), and cardiac power output (1.0±1.3 watts). Procedural survival stood at 99%, with survival rates to discharge, 30 days, and one year being 71%, 68%, and 53%, respectively.
The prompt application of MCS in AMI‐CS patients demonstrated feasibility across diverse healthcare settings, leading to early improvements in hemodynamics and organ perfusion. Encouragingly high survival rates were observed at hospital discharge. These promising outcomes underscore the need for randomized clinical trials to evaluate the standardized use of early MCS, adopting a multidisciplinary approach to managing AMI‐CS.
Source: ahajournals.org/doi/10.1161/JAHA.123.031401
