Abstract Background Cardiogenic shock (CS) after ST-segment elevation myocardial infarction (STEMI) is a potential lethal condition during which a profound inflammatory response often develops. In the Danish German Cardiogenic Shock (DanGer Shock) trial mortality was reduced by utilization of a microaxial flow pump (mAFP) compared to standard care alone in STEMI-CS. However, complications were more common in patients randomized to mAFP compared to standard care. Both STEMI-CS and mechanical circulatory support (MCS) including use mAFP can cause inflammation which could contribute to the development of mixed shock, and potentially affect the risk of death. Purpose To assess if mAFP compared to standard care causes additional systemic inflammation and examine the associated circulatory instability and risk of death. Methods The DanGer Shock trial randomized 360 STEMI-CS patients to either mAFP as an adjunctive treatment, or standard care alone. Patient characteristics at randomization were collected. Inflammation was characterized by C-reactive protein (CRP) at randomization, 24, 48, and 72 hours. Use of vasopressors and inotropy, signifying circulatory instability, was summarized by vasoactive-inotropy score (VIS) serially from randomization till 72 hours. To investigate associations between CRP and VIS, mean values of these variables during initial 72 hours were analyzed by Spearman’s correlation analysis. Death at 180 was recorded, and area under the receiver operator curve (AUROC) for the prediction of mortality, by mean CRP and VIS were calculated. Results The ITT population consist of 355 patients, and 285 had at least one of CRP-measurement after randomization. In this population, age was median 65 (IQR 57-74) and 68 (59-75), systolic blood pressure was 85 (75-91) and 85 (75-94), lactate was 4.3 (3.4-6.7) and 4.2 (3.1-6.6), and left ventricular ejection fraction was 25% (20-31) and 25% (15-30), at randomization for the mAFP and standard care groups respectively. There were no signs of differences in levels of CRP, between patients randomized to mAFP or standard care, p0.05 at all timepoints (Figure). Yet, both treatment groups had substantial magnitudes of CRP over the initial 72 hours. Mean CRP and VIS had a correlation of r=0.32 in both randomization groups, p0.001 for both. A higher mean CRP was associated with increased risk of death, AUROC 0.63 0.54-0.72 and 0.68 0.59-0.77, for the mAFP and standard care respectively. Conclusion Cardiogenic shock was accompanied by substantial systemic inflammation in both the microaxial flow pump and standard care groups. Higher levels of inflammation were associated with higher VIS and mortality for both treatment groups. There were no signs of differences in levels of inflammation between patients randomized to microaxial flow pump or standard care.
Meyer et al. (Sat,) studied this question.