SPC365

Impact of DanGer Shock Eligibility Criteria on Survival in Patients with Acute Myocardial Infarction-Related Cardiogenic Shock: It is all about Impella?

Session: SESSÃO DE COMUNICAÇÕES ORAIS 04 - INOVAÇÃO EM CUIDADOS INTENSIVOS: NOVAS INTERVENÇÕES EM CHOQUE CARDIOGÉNICO E SÍNDROMAS CORONÁRIAS AGUDAS
Speaker: Ana Débora Câmara De Sá

Congress: CPC 2025
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 14. Acute Cardiac Care
Subtheme: 14.4 Acute Cardiac Care – Cardiogenic Shock
Session Type: Comunicações Orais
FP Number: ---
Authors: Débora Sá; Joana Certo Pereira; Ana Rita Bello; Rita Carvalho; Débora Correia; Samuel Azevedo; Rita Barbosa; Christopher Strong; Jorge Ferreira; João Presume; António Tralhão; Catarina Brízido

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Introduction:</u></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The recently published DanGer Shock trial demonstrated that incorporating a microaxial flow pump (Impella) alongside standard care significantly reduced all-cause mortality at 180 days in patients with STEMI-related cardiogenic shock (CS) compared to standard care alone.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">As patient selection criteria across centers can challenge the applicability of trial findings to the real-world setting, we aimed to apply the study&rsquo;s eligibility criteria in an acute myocardial infarction (AMI) related CS population in Portugal, evaluating differences in clinical management and all-cause mortality in eligible and ineligible groups.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Methods: </u></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Retrospective single-center study of AMI-CS patients admitted to a cardiac intensive care unit (CICU) between January 2017 and October 2024. After applying eligibility criteria, eligible and ineligible groups were compared regarding baseline characteristics, CS severity, types of mechanical circulatory support (MCS) used and in-hospital complications. Mortality at 180 days was compared using Kaplan-Meier survival curves and predictors of survival obtained through bivariate logistic regression analysis.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Results: </u></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Our cohort included 181 patients with AMI-CS, of whom 85 (47%) met eligibility criteria for the DanGer shock trial (see flow-chat). </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Eligible patients were younger (64&plusmn;14 vs 71&plusmn;14 years, p=0.001), all underwent coronary angiography and were more frequently submitted to culprit vessel PCI (88% vs 63%, p&lt;0,001). Despite similar SCAI severity at admission, eligible patients had lower LV ejection fraction and received more MCS (53% vs 32%, p=0.005), with numerically higher device-related complications. The type of MCS used was similar in both groups (Table 1). </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Mortality at 30 and 180 days was significantly lower in the eligible group (46% vs 71%, and 55% vs 78%, p &lt; 0.001), regardless of the type of MCS used.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The predictors of survival in this population included being eligible for DanGer Shock trial (OR 0.35 95%CI: 0.18 &ndash; 0.67; p 0.002), being submitted to PCI, younger age, higher blood pressure upon admission and the absence of mechanical ventilation (see Table 2). </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Conclusion</u></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Less than half of all AMI-CS patients would be eligible for the DanGer Shock trial in a real-world CICU Portuguese population. These patients represented a subset with higher chances of survival, regardless of the type of MCS implanted. For ineligible patients, MCS should be carefully used, taking into consideration known predictors of survival to avoid futility.</span></span></p>