Acute Myocardial Infarction-related Cardiogenic Shock Research Articles

D-19 | Acute Myocardial Infarction-related Cardiogenic Shock Survivorship: A Pilot Study in Quality of Life

D-19 | Acute Myocardial Infarction-related Cardiogenic Shock Survivorship: A Pilot Study in Quality of Life

A randomized controlled trial of ivabradine in patients with acute myocardial infarction related cardiogenic shock.

. Acute myocardial infarction-related cardiogenic shock (AMI-CS) is often accompanied by tachycardia, which, in turn, increases myocardial oxygen consumption and hinders the use of ventricular assist devices, such as intra-aortic balloon pump. Evidence suggests that ivabradine may reduce heart rate (HR) without affecting other hemodynamic parameters. The aim of the present study was to determine the effect of ivabradine on reducing HR and changes in other hemodynamic parameters such as cardiac index (CI), in patients with AMI-CS and tachycardia. . A single-center, open label, randomized clinical trial included patients diagnosed with AMI-CS and tachycardia with >100 beats per minute (BPM). Heart rate, cardiac index, and other hemodynamic parameters measured by pulmonary flotation catheter were compared at 0, 6, 12, 24, and 48 hours after randomization. . A total of 12 patients were randomized; 6 received standard therapy, and 6 received ivabradine in addition to standard therapy. Baseline clinical characteristics were similar at randomization. A statistically significant lower heart rate was found at 12 hours (p=0.003) and 48 hours (p=0.029) after randomization, with differences of -23.3 (-8.2 to -38.4) BPM and -12.6 (-0.5 to -25.9) BPM, respectively. No differences in cardiac index, or any other evaluated hemodynamic parameters, length of hospital stay, nor mortality rate were noted between both groups. . The use of ivabradine in patients with AMI-CS was associated with a significant reduction in heart rate at 12 and 48 h, without affecting other hemodynamic parameters.

What's new in VA-ECMO for acute myocardial infarction-related cardiogenic shock.

What's new in VA-ECMO for acute myocardial infarction-related cardiogenic shock.

Bleeding complications, coagulation disorders, and their management in acute myocardial infarction-related cardiogenic shock rescued by veno-arterial ECMO: A retrospective cohort study

PurposeManagement of dual antiplatelet therapy (DAPT) in patients on venoarterial-extracorporeal membrane (VA-ECMO) after acute myocardial infarction (AMI) is challenging. Our objective was to describe the frequency, management and outcomes of severe bleeding complications and determine their occurrence risk factors. Material and methodsWe conducted a retrospective observational cohort study including post-AMI cardiogenic shock patients requiring VA-ECMO. Severe bleeding was defined based on the Bleeding Academic Research Consortium classification. We calculated multivariable Fine–Gray models to assess factors associated with risk of severe bleeding. ResultsFrom January 2015 to July 2019, 176 patients received VA-ECMO after AMI and 132 patients were included. Sixty-five (49%) patients died. Severe bleeding occurred in 39% of cases. Severe thrombocytopenia (< 50 G/L) and hypofibrinogenemia (<1,5 g/L) occurred in respectively 31% and 19% of patients. DAPT was stopped in 32% of patients with a 6% rate of stent thrombosis. Anticoagulation was stopped in 39% of patients. Using a multivariate competing risk model, female sex, time on ECMO, troponin at admission and Impella® implantation were independently associated with severe bleeding. ConclusionsBleeding complications and coagulation disorders were frequent and severe in patients on VA-ECMO after AMI, leading of antiplatelet therapy withdrawal in one third of patients.

Left ventricle unloading during acute myocardial infarction-related cardiogenic shock and reperfusion

Left ventricle unloading during acute myocardial infarction-related cardiogenic shock and reperfusion

SCAI Staging Application for Acute Myocardial Infarction-Related Cardiogenic Shock at a Single-Center Russian Registry.

To access the features of the course of myocardial infarction (MI) in patients with different stages of MI complicated by cardiogenic shock (MI CS) according to the SCAI scale. We retrospectively described the portrait of CS MI (n = 117) at different stages of SCAI from the hospital MI registry (n = 1253). Hospital mortality increased from stage to stage (p ≤ 0.001). Significant differences in biochemical parameters were found both for indicators characterizing intensive care measures, such as the presence of mechanical lung ventilation or an intra-aortic balloon pump, and for indicators of organ hypoperfusion such as lactate level, pHv (7.39 (7.36; 7.44) at stage A-B; 7.14 (7.06; 7.18) at stage E), creatinine, and glomerular filtration rate. Parameters related to MI characteristics, such as instrumental and laboratory data, anamnesis of ischemia, and performed treatment, did not differ between groups. Polynomial logistic regression showed that lactate level, mechanical ventilation, and monocyte count upon admission (1.15 (0.96; 1.23) at stage A-B; 0.78 (0.49; 0.94) at stage E, p = 0.005) correlated with CS severity. The characteristics of MI at different stages of SCAI do not have differences and do not determine the severity of shock. We revealed a high discriminatory potential of the pH level in predicting refractory shock. The value of monocytes at admission may be a promising predictor of the severity of MI CS. The question of the causes of heterogeneity of MI CS, taking into account the homogeneity of MI characteristics, remains open and promising.

Sex-related differences on short-term prognosis in patients with acute myocardial infarction related cardiogenic shock receiving Impella support in Japan

Abstract Background Sex-specific outcomes in patients with acute myocardial infarction related cardiogenic shock (AMI-CS) receiving temporary MCS remains controversial in the United States. Survival benefit of Impella support in female patients in Japan also remains uncertain. Purpose This study examined sex-related differences in clinical outcomes among patients with AMI-CS receiving Impella support using the prospective multi-center J-PVAD registry data. Methods We included patients with AMI-CS who received Impella-incorporated temporary MCS and were enrolled in the J-PVAD registry between Jan 2021 and Dec 2022. Patients with out-of-hospital cardiac arrest were excluded. The primary outcome was 30-day survival. Results A total of 979 patients (average 71 y; female 21%; LVEF 30%) were included. All patients received revascularization and 69% of them received during Impella support. Female patients had a lower 30-day survival compared to male patients (60.2% vs 67.9%, p = 0.0089). Of note, female patients who received Impella support before revascularization had a greater survival compared to those who received Impella support after revascularization (69.2% vs 41.8%, Figure 1). Conclusions Female patients in AMI-CS had a lower short-term prognosis compared to male. Early initiation of Impella support before revascularization is highly recommended for those with AMI-CS.

Obesity and outcomes in cardiogenic shock due to acute myocardial infarction

Abstract Background Obesity paradox in heart failure (HF) is defined as better outcomes associated with higher body mass index (BMI). Purpose We explored the relationship between BMI and outcomes in cardiogenic shock (CS) due to acute myocardial infarction. Methods The Cardiogenic Shock Working Group (CSWG) registry includes patients with CS, regardless of etiology, from 17 clinical sites across the USA. In- hospital mortality, as a main outcome measure, was analyzed depending on BMI as a continuous variable, as well as BMI quartiles (BMI≤24.4 kg/m2, 24.433.1 kg/m2) for the subset of CS due to acute myocardial infarction (AMI-CS). We also explored mortality in categorized BMI subsets (underweight, normal weight, overweight, obese, and morbidly obese). Results A total of 969 patients with AMI-CS were included. The in-hospital mortality was 42.4%. When analyzed as a continuous variable, BMI had no association with survival to discharge. When the cohort was divided into quartiles according to BMI, mortality was consistent with 42.2%, 38.5%, 39.5%, and 49.3%, respectively, p=0.082. In categorized subsets, mortality was 30% in the underweight, 42.9% in the normal weight, 37.4% in the overweight, 44.5.% in the obese, and 47.9% in morbidly obese, p=0.15. Conclusions In acute myocardial infarction-related cardiogenic shock, obesity creates no survival advantage.

Veno-arterial extracorporeal membrane oxygenation for cardiogenic shock: one-year outcomes from a cardiac intensive care unit led shock team program

Abstract Background Mechanical circulatory support (MCS) with peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used for severe cardiogenic shock (CS). Purpose To describe the initial experience with peripheral VA-ECMO within a cardiac intensivist team led program. Methods Retrospective analysis of a short-term MCS prospective registry, from 1 September 2021 to 1 December 2022. Clinical and device related variables were reviewed and reported. We assessed both patient outcomes as well as ECMO-related complications. Results A total of 21 patients were included in this analysis (50 ± 13 years-old, 80% male), ranging from SCAI-C (n = 8) to E (n = 5) and with a median predicted mortality by SAVE score of -4 points [IQ -6 - 0] (corresponding to 30% in-hospital survival). All cannulations were done percutaneously, mostly by trained cardiac intensivists and while at the CICU (n = 12). A femoro-femoral configuration was used for all patients. One patient was cannulated at the referring hospital and retrieved to our unit for further care. Three patients were cannulated during intra-hospital cardiac arrest and one patient was cannulated while breathing spontaneously (awake-ECMO). Mean venous and arterial cannula sizes were 22 ± 1.9 Fr and 17 ± 1.6 Fr, respectively. A 7 French (Fr) arterial limb reperfusion cannula was used in 85% of cases. The most frequent etiology was acute decompensation of chronic heart failure (n = 7), followed by acute myocardial infarction related CS (n = 5), fulminant myocarditis (n = 2) and massive pulmonary thromboembolism (n = 2). A left ventricle venting device was used in 70% of patients [intra-aortic balloon pump (n = 10); percutaneous microaxial pump ( n = 2)] and upgrade to a veno-arterio-venous configuration was necessary in one patient due to differential hypoxemia. Mean ECMO-run duration was 8.4 ± 4.8 days while mean CICU length of stay was 22 ± 17.9 In-hospital mortality was 40%. In survivors, decannulation was surgical in all but one patient. The most frequent strategy was bridge to recovery (n = 14). One patient was bridged directly to heart transplant, one to a temporary centrifugal left ventricular assist device (LVAD) and one to a durable magnetically levitated LVAD. Complications were common and included bleeding from cannula insertion sites (n = 19), renal replacement therapy requirement (n= 10), Harlequin syndrome (n = 2), cardiac tamponade (n = 2), intestinal ischemia (n = 3) and limb ischemia (n = 2). Conclusion VA-ECMO performed by cardiac intensivists is a feasible MCS strategy for severe cardiogenic shock patients in whom mortality, while high, was similar to large international published series. Further experience will allow for improvement in patient selection and minimization of device related complications.ECMO VA 1 year single-center experience

Abstract 18559: Sex Differences In Acute Myocardial Infarction Related Cardiogenic Shock Across Different Levels Of Care

Background Previous registry data have suggested important sex-based differences in management and clinical outcomes for patients with acute myocardial infarction related cardiogenic shock (AMI-CS). Methods: We classified 11 hospitals in a metropolitan health network as different levels of care (LOC) for CS based on their highest mechanical circulatory support (MCS) capability; L1: Durable LVAD, L1A: ECMO, L2: Impella. We identified all patients ≥ 18 years of age treated for AMI-CS (ICD-10 diagnosis codes) from 2016 to 2022. Sex differences in management and hospital outcomes are reported. Descriptive statistics and logistic regression were performed using PRISM version 9. Results: In our cohort (n=1,956), women were a minority in L1 (30%) and L1A (31%) and L2 (41%) and were older with decreasing LOC, L1: 72y. (61-81), L1A: 74y. (64-82) and L2: 81y. (72-88), p&lt;0.01 for trend.Across LOC, left heart catheterization (LHC) and percutaneous coronary interventions (PCI) were used similarly in women and men, while coronary artery bypass grafting (CABG) in surgical centers (L1 and L1A) and MCS in PCI centers (except L1A) were used more frequently in men (Figure). After adjustment for LOC and other relevant covariates, female sex (aOR: 1.35, 95%CI: 1.09-1.67; p=0.007), age (aOR: 1.04, 95%CI: 1.03-1.05, p&lt;0.001) and admission cardiac arrest (aOR: 5.36, 95%CI: 3.63-8.54, p&lt;0.001) were associated with higher hospital mortality. Conclusion: In a metropolitan health system, despite similar rates of LHC and PCI across different LOC, women with AMI-CS received less CABG and MCS than men and had higher adjusted hospital mortality.

TCT-535 Association Between Sex and Clinical Presentation and Outcome in Acute Myocardial Infarction-Related Cardiogenic Shock

TCT-535 Association Between Sex and Clinical Presentation and Outcome in Acute Myocardial Infarction-Related Cardiogenic Shock

Sex-Related Differences in Short-Term Prognosis in Patients with Acute Myocardial Infarction-Related Cardiogenic Shock Receiving Impella Support in Japan: From the J-PVAD Registry.

Background and Objectives: Sex-specific outcome in patients with acute myocardial infarction-related cardiogenic shock (AMI-CS) receiving temporary mechanical circulatory support remains controversial. Materials and Methods: Patients with AMI-CS who received Impella support were prospectively enrolled in the Japanese registry for Percutaneous Ventricular Assist Device. Patients enrolled between January 2021 and December 2022 were considered to be eligible. Patients with out-of-hospital cardiac arrest and those without revascularization were excluded. The sex disparity in the 30-day survival after the initiation of Impella support was evaluated. Results: A total of 924 patients (median age 73 years; 21% female) were included. Female patients were older and had a smaller physiques than male patients (p < 0.05 for both). Female sex was significantly associated with a higher 30-day mortality after adjustment for four other potential confounders with a hazard ratio of 1.365 (95% confidence interval 1.026-1.816, p = 0.0324). In the female cohort, patients who received Impella prior to revascularization (N = 138) had a greater survival rate compared to those who received Impella after revascularization (68.1% versus 44.8%, p = 0.0015). Conclusions: Among the patients with AMI-CS who received Impella support and underwent revascularization, female sex was independently associated with a lower 30-day survival. For female patients, early initiation of Impella support prior to revascularization may improve their clinical outcomes.

COMPARISON OF THE PREDICTIVE PERFORMANCE OF CARDIOGENIC SHOCK SCORES IN A REAL-WORLD LATIN AMERICA COUNTRY.

Background : Mortality in cardiogenic shock (CS) is up to 40%, and although risk scores have been proposed to stratify and assess mortality in CS, they have been shown to have inconsistent performance. The purpose was to compare CS prognostic scores and describe their performance in a real-world Latin American country. Methods : We included 872 patients with CS. The Society for Cardiovascular Angiography and Interventions (SCAI), CARDSHOCK, IABP-Shock II, Cardiogenic Shock Score, age-lactate-creatinine score, Get-With-The-Guidelines Heart Failure score, and Acute Decompensated Heart Failure National Registry scores were calculated. Decision curve analyses were performed to evaluate the net benefit of the different scoring systems. Logistic and Cox regression analyses were applied to construct area under the curve (AUC) statistics, this last one against time using the Inverse Probability of Censoring Weighting method, for in-hospital mortality prediction. Results: When logistic regression was applied, the scores had a moderate-good performance in the overall cohort that was higher AUC in the CARDSHOCK ( c = 0.666). In acute myocardial infarction-related CS (AMI-CS), CARDSHOCK still is the highest AUC (0.68). In non-AMI-CS only SCAI (0.668), CARDSHOCK (0.533), and IABP-SHOCK II (0.636) had statistically significant values. When analyzed over time, significant differences arose in the AUC, suggesting that a time-sensitive component influenced the prediction of mortality. The highest AUC was for the CARDSHOCK score (0.658), followed by SCAI (0.622). In AMI-CS-related, the highest AUC was for the CARDSHOCK score (0.671). In non-AMI-CS, SCAI was the best (0.642). Conclusions : Clinical scores show a time-sensitive AUC, suggesting that performance could be influenced by time and the type of CS. Understanding the temporal influence on the scores could provide a better prediction and be a valuable tool in CS.

A total closed chest swine model of acute myocardial infarction-related cardiogenic shock: A critical double coronary sub-occlusion approach

The management of acute myocardial infarction-related cardiogenic shock (AMICS) represents a significant challenge, with mortality rates remaining high (40–60%), despite recent advances. Current animal models of myocardial infarction are either associated with a very high rate of per-procedure malignant arrhythmia, or with very low impairment of hemodynamic parameters, or with the inability to have complete coronary reperfusion. We sought to develop a closed chest and clinically relevant large animal model of severe AMICS, with high survival rate. Adult pigs were anaesthetized and mechanically ventilated. Percutaneous cardiac catheterization was performed under fluoroscopy. Advanced left ventricular dysfunction was induced by 120 minutes of critical sub-occlusion of the proximal left anterior descending coronary artery and the mid circumflex artery. A thorough hemodynamic assessment was obtained by invasive and non-invasive monitoring devices. Repeated blood samples were obtained to determine blood gas parameters, lactate, and haemoglobin concentration. After death, the heart was retrieved for further histological analyses. All animals (n = 12) developed significant circulatory failure associated with AMICS upon reperfusion and beyond. No animal died during the ischemia process. However, all animals that did not benefited from vasopressor support (“sham” group, n = 4) spontaneously died within 30 minutes of reperfusion, confirming the severity of the model. Cardiogenic shock was characterized by a drop in mean arterial pressure below 60 mmHg (58 ± 5 mmHg at 120 min of ischemia), a significant decrease in mean cardiac output (−44% from 5.7 ± 0.4 at baseline to 3.2 ± 0.4 at 120 minutes of ischemia) and SvO2 (−32% from 57 ± 8 at baseline to 39 ± 6 at 120 minutes of ischemia) and a significant increase in left ventricle end-diastolic pressure (LVEDP) (+110% from 10 ± 3 at baseline to 21 ± 3 at 120 minutes of ischemia). CO2 gap and coronary sinus venous oxygen saturation increased significantly upon ischemia and reperfusion and remained elevated throughout (P ≤ 0.001 for all comparisons). Myocardial samples corroborated extensive cellular necrosis and inflammatory infiltrates. We present, for the first time, a stable and clinically relevant model of severe AMICS obtained by critical double coronary sub-occlusion. The greater severity of the model did not lead to an increase in the frequency of malignant arrythmias and per-procedure mortality.

Abstract 11098: End-Organ Dysfunction Differs in Patients With Heart Failure-Related vs. Acute Myocardial Infarction-Related Cardiogenic Shock

Introduction: Severity of end-organ dysfunction correlates with outcomes in acute myocardial infarction-related cardiogenic shock (AMI-CS). The epidemiology of end-organ dysfunction in heart failure-related cardiogenic shock (HF-CS) has not been well described. Methods: Cardiac intensive care unit (CICU) admissions with CS in the Critical Care Cardiology Trials Network Registry (2017-2021) were identified and categorized as AMI-CS and HF-CS ( de novo or acute-on-chronic HF). Admissions for each CS sub-type were characterized as having respiratory, kidney, liver, and/or neurologic dysfunction using definitions adapted from the Sequential Organ Failure Assessment score ( Fig A ). Outcomes were assessed by burden of non-cardiac organ dysfunction: no end-organ dysfunction (NEOD), single system end-organ dysfunction (SEOD), or multi-system end-organ dysfunction (MEOD). Results: A total of 2,911 CS admissions from 35 CICUs were identified, most of which were for HF-CS (71%, N = 2,068). The proportions of patients with NEOD, SEOD, and MEOD were 25%, 36%, 39% for HF-CS vs. 16%, 35%, 49% for AMI-CS (p&lt;0.01). NEOD, SEOD, and MEOD rates were 19%, 31%, and 49% for de novo HF-CS vs. 27%, 37%, and 36% for acute-on-chronic HF-CS (p&lt;0.01). Predominant type of organ dysfunction differed among CS sub-types, with higher rates of respiratory dysfunction in AMI-CS and de novo HF-CS (p&lt;0.01) and higher rates of hepatic dysfunction in both de novo and acute-on-chronic HF-CS (p&lt;0.01; Fig A ). In-hospital mortality was lower in acute-on-chronic HF-CS compared with de novo HF-CS or AMI-CS (25% vs. 32% vs. 38%; p&lt;0.01), with a similar gradient of risk according to burden of non-cardiac organ dysfunction (p int = 0.64; Fig B ). Conclusions: End-organ dysfunction pattern and burden differ among de novo HF-CS, acute-on-chronic HF-CS, and AMI-CS. Overall mortality is lowest in acute-on-chronic HF-CS, but mortality is similarly associated with burden of end-organ dysfunction among CS types.

Abstract 14086: Do Outcomes Differ Between STEMI and NSTEMI Cardiogenic Shock?

Background: Acute myocardial infarction relatedcardiogenic shock (AMI-CS) is a multifactorial syndrome with high morbidity andmortality. Contemporary, real-world data comparing outcomes among patients withST-elevation myocardial infarction related CS (STEMI-CS) versus non-STEMI(NSTEMI-CS) is lacking. Methods: Using data from 17 sites from the CardiogenicShock Working Group (CSWG) registry, we compared the clinical characteristics,hemodynamic, and metabolic profiles between STEMI-CS and NSTEMI-CS patients. Between 2016 to 2020, data from 1110 adultpatient hospital admissions with the diagnosis of AMI-CS were collected. Patientswith available data within 24 hours of admission were stratified according to baselineand maximum SCAI Stage. We performed comparison between STEMI vs NSTEMI groupusing one-way Anova analysis. Results: Among 1,110 patients with AMI-CS, 731(65.8%) had STEMI-CS and 379 (34.2%) had NSTEMI-CS. Most patients were male andwhite. Compared with NSTEMI-CS patients, STEMI-CS patients were younger (63.8±12.3 vs 69.2 ± 12.3, p&lt;0.001). Overall unadjusted in-hospital mortality was41%. Mortality was similar among STEMI-CS and NSTEMI-CS patients (43% vs 39%,p=0.23). Patients with out-of-hospital (OHCA) or in-hospital cardiac arrest (IHCA)had higher in-hospital mortality (55% vs 39%, p =0.002; 62%% vs 33%, p&lt;0.001, respectively) (Fig 1A).Shock severity defined by SCAI Stage within 24 hours of admission (baseline)and throughout hospitalization (maximum) directly correlated with in-hospitalmortality in both STEMI- and NSTEMI-CS (Fig 1B). Conclusion: We report one of the largest contemporary analysesspecifically comparing outcomes with STEMI-CS and NSTEMI-CS. Cardiac arrest is an important determinant ofmortality and SCAI Stages are directly associated with poor outcomes in bothcohorts.

Comparison of Risk Models in the Prediction of 30-Day Mortality in Acute Myocardial Infarction–Associated Cardiogenic Shock

BackgroundThere are numerous risk-prediction models applied to acute myocardial infarction–related cardiogenic shock (AMI-CS) patients to determine a more accurate prognosis and to assist in patient triage. There is wide heterogeneity among the risk models including the nature of predictors evaluated and their specific outcome measures. The aim of this analysis was to evaluate the performance of 20 risk-prediction models in AMI-CS patients. MethodsPatients included in our analysis were admitted to a tertiary care cardiac intensive care unit with AMI-CS. Twenty risk-prediction models were computed utilizing vitals assessments, laboratory investigations, hemodynamic markers, and vasopressor, inotropic and mechanical circulatory support available from within the first 24 ​hours of presentation. Receiver operating characteristic curves were used to assess the prediction of 30-day mortality. Calibration was assessed with a Hosmer-Lemeshow test. ResultsSeventy patients (median age 63 years, 67% male) were admitted between 2017 and 2021. The models' area under the curve (AUC) ranged from 0.49 to 0.79, with the Simplified Acute Physiology Score II score having the most optimal discrimination of 30-day mortality (AUC: 0.79, 95% confidence interval [CI]: 0.67-0.90), followed by the Acute Physiology and Chronic Health Evaluation-III score (AUC: 0.72, 95% CI: 0.59-0.84) and the Acute Physiology and Chronic Health Evaluation-II score (AUC: 0.67, 95% CI: 0.55-0.80). All 20 risk scores demonstrated adequate calibration (p > 0.05 for all). ConclusionsAmong the models tested in a data set of patients admitted with AMI-CS, the Simplified Acute Physiology Score II risk score model demonstrated the highest prognostic accuracy. Further investigations are required to improve the discriminative capabilities of these models or to establish new, more streamlined and accurate methods for mortality prognostication in AMI-CS.

Impact of the elevated angiopoietin-2 levels during Impella support on the short-term prognosis.

Elevated serum angiopoietin-2 levels in patients with acute myocardial infarction-related cardiogenic shock with and without intra-aortic balloon pump as well as acute decompensated heart failure are associated with short-term mortality. However, its prognostic impact in patients with cardiogenic shock supported by Impella-incorporated mechanical circulatory support (MCS) remains unknown. Patients who received temporary MCS (Impella alone or Impella and veno-arterial extracorporeal membrane oxygenation) in our institute between August 2018 and January 2022 were included in this prospective study. The serum levels of angiopoietin-2 were measured just before and following the initiation of temporary MCS therapy. Association between the levels of serum angiopoietin-2 and 30-day mortality was investigated. A total of 38 patients (median 72years old, 63% men) were included. The median levels of serum angiopoetin-2 tended to decrease from baseline to 4days following the initiation of temporary MCS from 5.2 (3.3, 10.5)ng/mL to 4.8 (2.7, 6.8)ng/mL (p = 0.132). A higher angiopoietin-2 (> 6.8ng/mL) following the initiation of temporary MCS was associated with higher 30-day mortality (89.7% versus 44.4%, p = 0.0048) with an odds ratio 18.946 (95% confidence interval 1.624-218.695, p = 0.018) adjusted for potential confounders. A higher serum angiopoietin-2 level following the initiation of Impella-incorporated temporary MCS, instead of baseline angiopoetin-2 level, was associated with higher short-term mortality.

Age stratified sex-related differences in incidence, management, andoutcomes of cardiogenic shock.

There is a lack of data on age-stratified sex differences in the incidence, treatment, and outcomes of cardiogenic shock (CS). We sought to study these differences from a contemporary database. Patients admitted with CS (2004-2018) were identified from the United States National Inpatient Sample. We compared CS (acute myocardial infarction-related cardiogenic shock [AMI-CS] and non-acute myocardial infarction-related cardiogenic shock [Non-AMI-CS]) incidence, management, and outcomes in males and females, stratified into four age groups (20-44, 45-64, 65-84, and ≥85 years of age). Propensity score matching (PSM) was used for adjustment. A total of 1,506,281 weighted hospitalizations for CS were included (AMI-CS, 39%; Non-AMI-CS, 61%). Across all age groups, females had a lower incidence of CS compared with males. After PSM and among the AMI-CS cohort, higher mortality among females compared with males was observed in the age groups 45-64(28.5% vs. 26.3%) and 65-84 years(39.3% vs. 37.9%) (p < 0.01, for all). Among the Non-AMI-CS cohort, higher mortality among females compared with males was observed in the age groups20-44 (33.5% vs. 30.5%), 45-64(35.1% vs. 31.9%), and 65-84 years(41.7% vs. 40.3%) (p < 0.01, for all). Similar age-dependent differences in the management of CS were also observed between females and males. Females have a lower incidence of CS regardless of age. Significant disparities in the management and outcomes of CS were observed based on sex. However, these disparities varied by age and etiology of CS (AMI-CS vs. Non-AMI-CS) with pronounced disparity among females in the age range of 45-84 years.

Abstract 10466: Randomized Clinical Trials Assessing Patients with Acute Myocardial Infarction-Related Cardiogenic Shock - A Systematic Review of Used Cardiogenic Shock Definitions and Outcomes

Introduction: Cardiogenic shock (CS) is a critical complication to acute myocardial infarction (AMI), with short-term mortality rates exceeding 40%. However, the definition of CS varies between trials, which may comprise interstudy comparability. Aim: The aim of the current study was to review differences and similarities of CS definitions used in randomized clinical trials (RCT) assessing patients with AMI-related CS. Methods: From the electronic databases MEDLINE and EMBASE we identified 19 AMI-related CS trials comprising a total of 2674 unique patients with CS. Results: Seven trials investigated left ventricular assist devices, eight investigated medical treatments, three percutaneous coronary interventions, and one trial investigated targeted temperature management. The inclusion criteria, baseline hemodynamics, endpoints and mortality varied markedly between trials. Hypotension was the most frequent inclusion criterion (17 (90%) trials), with a systolic blood pressure value &lt;90mmHg combined with vasopressor use as the most frequent definition, Figure. Twelve (63%) trials had signs of impaired end-organ perfusion as an inclusion criterion and 10 (53%) signs of impaired cardiovascular function most frequently low cardiac index and reduced left ventricular ejection fraction. Ten (53%) trials included patients resuscitated from a cardiac arrest, three trials excluded cardiac arrest-patients whereas six trials did not state whether cardiac arrest was an exclusion criterion. Mortality ranged from 8 % to 73%. Conclusions: RCTs of AMI-related CS show marked heterogeneity in inclusion criteria and outcomes potentially hampering interstudy comparability. Consensus criteria for CS appear needed for future selection of patients.