Microaxial flow pump support in a real-world STEMI-CS cohort resulted in 180-day all-cause mortality comparable to the DanGer Shock registry (50.0% vs 45.8%, p=0.801).
Cohort (n=16)
No
Does microaxial flow pump use improve all-cause mortality at 180 days in STEMI-related cardiogenic shock compared to the DanGer Shock cohort?
Real-world use of microaxial flow pumps in STEMI-related cardiogenic shock demonstrated 180-day mortality and safety outcomes comparable to the DanGer Shock trial, supporting its effectiveness when careful patient selection is applied.
Absolute Event Rate: 50% vs 45.8%
p-value: p=0.801
Abstract Background Cardiogenic shock(CS) remains associated with high mortality in patients with ST-segment elevation myocardial infarction(STEMI). The DanGer Shock study demonstrated that the use of a microaxial flow pump reduces six-month mortality compared with standard treatment, although it is associated with a higher rate of complications. Evaluating real-world experience is essential to determine its effectiveness and safety beyond controlled trial conditions. Purpose To compare the clinical characteristics, outcomes and safety of patients with STEMI-related cardiogenic shock(STEMI-CS) treated with a microaxial flow pump at our centre with those from the DanGer Shock cohort. Methods A retrospective single-centre study including STEMI-CS patients supported with a microaxial flow pump. The primary endpoint was all-cause mortality at 180 days. The composite cardiac endpoint was defined as escalation of treatment to additional mechanical circulatory support, heart transplantation or death from any cause. The composite safety endpoint included severe bleeding, limb ischaemia, haemolysis, device failure, or worsening of aortic regurgitation. Additional outcomes assessed were moderate or severe bleeding, limb ischaemia, renal replacement therapy, stroke, and sepsis with a positive blood culture. Results Among patients who received microaxial flow pump support at our centre, 16 had STEMI-CS. In both cohorts, the majority of patients were male (82.4% vs 79.3%, p=0.768). The mean age in our centre was 65±12 years, similar to the DanGer Shock population (median 6758–76 years). In our cohort, 81% (n=13) of the patients had severely reduced left ventricular ejection fraction at admission. All microaxial flow pumps were implanted during emergent percutaneous coronary intervention after hospital admission.Baseline characteristics are summarised in Table 1. The 180-day mortality was similar between groups (50.0%vs45.8%, p=0.801). The composite cardiac endpoint occurred in 56.3% of patients at our centre versus 52.5% in the DanGer Shock registry (p=0.798). There were no significant differences in the composite safety endpoint (31.3%vs24.0%,p=0.520). No significant differences were found for stroke (0% vs 3.9%, p =1.000), limb ischaemia (12.5% vs 5.6%,p=0.257), sepsis with positive blood cultures (6.3%vs11.7%, p=0.507) and moderate or severe bleeding (37.5% vs 21.8%, p=0.153). The need for escalation to extracorporeal membrane oxygenation (ECMO) was similar between groups (12.5%vs11.7%,p=0.927). Renal replacement therapy was significantly lower in our cohort (12.5%vs41.9%,p=0.021). Conclusions In this single-centre, microaxial flow pump support was associated with survival and safety outcomes comparable to those reported in the DanGer Shock registry. These findings suggest that careful patient selection, aligned with the DanGer Shock criteria, may be crucial to optimize the clinical benefit of microaxial flow pump use in real-world practice.Table1.
Silva et al. (Fri,) conducted a cohort in STEMI-related cardiogenic shock (STEMI-CS) (n=16). Microaxial flow pump vs. DanGer Shock cohort was evaluated on all-cause mortality at 180 days (p=0.801). Microaxial flow pump support in a real-world STEMI-CS cohort resulted in 180-day all-cause mortality comparable to the DanGer Shock registry (50.0% vs 45.8%, p=0.801).