Author + information
- Mir Basir1,
- Iyad Isseh1,
- Theodore Schreiber2,
- Amir Kaki2,
- John Finley3,
- David Lasorda4,
- Malcolm Foster5,
- Behnam Tehrani6,
- Alexander Truesdell7,
- Thomas Lalonde8,
- Michael Green9,
- Yasir Akhtar10,
- Simon Dixon11 and
- William O'Neill1
- 1Henry Ford Hospital, Detroit, Michigan, United States
- 2Detroit Medical Center, Detroit, Michigan, United States
- 3Mercy Fitzgerald Hospital, Darby, Pennsylvania, United States
- 4Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
- 5Tenova, Knoxville, Tennessee, United States
- 6INOVA Heart and Vascular Institute, Annandale, Virginia, United States
- 7Virginia Heart, McLean, Virginia, United States
- 8St. John Hospital and Medical Center, Grosse Pointe Shores, Michigan, United States
- 9Northwest Medical Center, Springdale, Arkansas, United States
- 10Tennova Health, Knoxville, Tennessee, United States
- 11Beaumont Hospital, Royal Oak, Michigan, United States
The National Cardiogenic Shock Initiative is a single-arm, multicenter study to assess the feasibility of early mechanical circulatory support (MCS) in patients presenting with acute myocardial infarction complicated by cardiogenic shock (AMICS) and treated with percutaneous coronary intervention (PCI). We wished to evaluate the prognostic value of cardiac power output and lactate levels on survival in this cohort.
Between July 2016 and May 2018, 13 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 criteria being use of intra-aortic balloon pump counter-pulsation prior to MCS.
A total of 80 consecutive patients were enrolled. Patients had an average age of 64 +/- 12 years, 75% were male, 68% were admitted with AMICS, while 32% developed shock during the index hospitalization. Prior to MCS, 84% of patients were on vasopressors or inotropes, 21% had witnessed out of hospital cardiac arrest, 35% had in-hospital cardiac arrest and 15% were under active cardiopulmonary resuscitation during MCS implantation. In accordance with the protocol, 78% of patients had a MCS device inserted prior to PCI. Right heart catheterization was performed in 91%. Survival to discharge was 75%. Lactate and cardiac power output measurements at 12-24 hours reliably predicted overall mortality. Lactate ≥4 mg/dL demonstrated a 77% sensitivity with a false positive rate (FPR) of 18% for predicting mortality. A CPO ≤0.6 (irrespective of the use of vasopressors or inotropes) demonstrated a 77% sensitivity with a FPR of 50% for predicting mortality. A combined lactate <4 mg/dl and CPO >0.6W at 12-24 hours was associated with high survival (Survival 97% vs 47%; p<0.01).
Lactate and cardiac power output reliably predict outcomes in patients with AMICS treated with MCS.
CORONARY: Hemodynamic Support and Cardiogenic Shock