Impact of early mechanical support in patients with acute myocardial infarction complicated by cardiogenic shock with culprit left main coronary artery disease: Insights from national cardiogenic shock initiative
Jain T, Lemor A, Basir M, Kapur NK, Schreiber TL, Kaki A, Patel K, Wilkins CE, Senter SR, Akhtar Y, Lasorda DM, Foster M, Kolski BC, Tehrani BN, Lalonde TA, Green M, Finley JJ, Larkin TJ, Dupont AG, O'Neill B, McAllister D, Martin S, Marso SP, Hanson I, Blank N, Johnson T, Hacala M, and O'Neill W. Impact of early mechanical support in patients with acute myocardial infarction complicated by cardiogenic shock with culprit left main coronary artery disease: Insights from national cardiogenic shock initiative. Catheter Cardiovasc Interv 2019; 93(Suppl 2):S100-S101.
Catheter Cardiovasc Interv
Background: Previous retrospective studies have demonstrated unacceptably high hospital mortality (60-65%) in patients presenting with acute myocardial infarction complicated by cardiogenic shock (AMICS) undergoing primary percutaneous coronary intervention (PCI) of a culprit left main coronary artery (LMCA). We sought to assess the impact of early mechanical support (MCS) specifically in this cohort using data from the National Cardiogenic Shock Initiative, a single-arm, prospective, multicenter study. Methods: Between July 2016 and August 2018, 23 sites participated in the study. All centers agreed to treat patients with AMICS using a standard protocol emphasizing invasive hemodynamic monitoring and rapid initiation of MCS. Inclusion and exclusion criteria mimicked those of the 'SHOCK' trial with an additional exclusion criterion being use of intra-aortic balloon pump counter-pulsation prior to MCS. Results: Out of a total of 104 patients enrolled, 16 patients had a culprit LMCA. In the culprit LMCA cohort, the mean age was 64 ± 11 years and 75% were males. Prior to MCS, 25% had witnessed out of hospital cardiac arrest, 25% had in-hospital cardiac arrest and 32% were under active cardiopulmonary resuscitation during MCS implantation. In accordance with the protocol, 87% of patients had an MCS device inserted prior to PCI. Right heart catheterization and hemodynamic monitoring was performed in 84% of patients. Cardiac power output improved from 0.68 W pre-procedure to 0.98 W 24-hours post-procedure (p = 0.04). TIMI III flow was achieved in 88% of patients post-reperfusion. Mean length of stay was 16 days. Left ventricle ejection fraction improved from 12.5 ± 3.8 % baseline to 25.6 ± 9.6 % at the time of discharge (p = 0.002). Survival to explant was 94% and survival to discharge was 75%. Conclusions: Early MCS in patients with AMICS with a culprit LMCA was associated with rapid improvement in hemodynamics and improved survival to discharge.