Abstract 13759: Impact of Shock Network Protocols on Reducing Cardiogenic Shock Death in STEMI Cases: A Middle Eastern Study

Abstract

Introduction: The optimal use of mechanical circulatory support (MCS) in managing acute myocardial infarction with cardiogenic shock (AMICS) treated with percutaneous coronary intervention (PCI) remains a complex clinical challenge. In response to this, our study seeks to explore the implementation of a systematic Shock Protocol that integrates pre-PCI MCS in patients presenting with STEMI and SCAI class C and above. Hypothesis: Utilizing a prospective, multi-centre STEMI database, our study aimed to assess the impact of the Shock Protocol on survival at hospital discharge. Methods: From January 2022 to February 2023, five participating sites within our STEMI network committed to the study, adhering to a standardized protocol for AMICS treatment. The selection criteria mirrored those of the "SHOCK" trial. The survival rate at hospital discharge for this cohort was compared to pre-protocol implementation (October 2020-December 2021). Results: Of 745 STEMI cases, 418 and 327 were treated before and after protocol implementation. AMICS diagnoses were in 10.5% and 10.7% in the BSP and ASP groups, respectively. The mean ages were 53 (BSP) and 51 (ASP), with 90% males. Approximately 83% and 85% of BSP and ASP patients, respectively, were on vasopressors or inotropes at Cath-Lab arrival. Pre-Cath-Lab cardiac arrests (CA) occurred in 20% (BSP) and 33% (ASP), while post-arrival CA incidence was 30% (BSP) and 12% (ASP). MCS was used in 27% (BSP) and 87% (ASP). In ASP, 85% of devices were implanted pre-PCI. Median FMC-to-balloon times were 104 ±28.2 (BSP) and 77 ±41.6 (ASP) minutes. Discharge survival rates were 77% (BSP) and 82% (ASP). Mortality predictors: TIMI flow <3 post-PCI, post-Cath-Lab CA, and SCAI class D/E. In SCAI class D/E patients, protocol implementation enhanced survival at hospital discharge. Conclusions: In our STEMI network, upfront MCS use in AMICS patients improved post-discharge survival.