TCT CONNECT-29 Vasopressors Have Independent Adverse Impact on Survival in Patients With Acute Myocardial Infarction Cardiogenic Shock
Basir M, Taylor A, Lemor A, Gorgis S, Tehrani B, Truesdell A, Bharadwaj A, Kolski B, Gelormini J, Todd J, Lasorda D, Smith C, Riley R, Marso S, Federici R, and O'Neill W. TCT CONNECT-29 Vasopressors Have Independent Adverse Impact on Survival in Patients With Acute Myocardial Infarction Cardiogenic Shock. Journal of the American College of Cardiology 2020; 76(17):B13.
Journal of the American College of Cardiology
Background: Increasing doses of vasopressors are associated with increased mortality in patients presenting with acute myocardial infarction and cardiogenic shock (AMICS). A causal link to independent harm is confounded by the fact that higher levels of vasopressors may be related to decreasing intrinsic cardiac power output (CPO).
Methods: The NCSI is a single-arm prospective trial using mechanical circulatory support (MCS) with Impella for patients with AMICS. Early initiation of MCS placement pre–percutaneous coronary intervention (PCI) and rapid de-escalation of vasopressors guided by systematic use of hemodynamic measures led to a 70% in hospital survival rate for the first 300 patients enrolled from July 2016 to December 2019 in 57 sites. Because MCS can enhance CPO and decrease needs for vasopressors, we were able to assess the independent impact of increasing dosing of vasopressors on survival.
Results: Hemodynamic measurements were obtained on patients immediately after MCS and PCI. Survival curves were constructed based on CPO and use of vasopressors (Figure). For patients with CPO ≤0.6 W, survival rate was (77.3%, 45.0%, and 35.3; p = 0.02) when 0, 1, or ≥2 inotropes were used, respectively. Similarly, for patients with CPO ≥0.6 W, survival rate was (81.7%, 72.6%, and 56.8%; p = 0.01), respectively. Logistic regression analysis demonstrates that increasing requirements for inotropes were independently associated with an increase in mortality (p = 0.02).
Conclusion: Increasing requirements for vasopressors are associated with an increase in mortality in AMICS irrespective of underlying CPO. Methods to decrease need for vasopressors may enhance survival in AMICS.