What is the clinical evidence from this study?

Study design: RCT. Population: Adults with myocardial infarction-related cardiogenic shock classified into three phenotypes: non-congested, cardiorenal, and cardiometabolic (n=355). Intervention: microaxial flow pump (mAFP) vs. standard of care. Primary outcome: 180-day all-cause mortality (OR 0.51 for non-congested CS, OR 0.81 for cardiometabolic CS, OR 0.91 for cardiorenal CS, 95% CI 0.28-0.91 for non-congested CS, 0.57-1.16 for cardiometabolic CS, 0.35-2.34 for cardiorenal CS, p=0.02 for non-congested CS, 0.25 for cardiometabolic CS, 0.84 for cardiorenal CS).

What does this research mean for the field?

Microaxial flow pump use reduces 180-day mortality specifically in the non-congested phenotype of myocardial infarction-related cardiogenic shock. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This analysis aims to evaluate the outcomes and trajectories of different cardiogenic shock phenotypes using microaxial flow pumps.

March 6, 2026Open Access

Microaxial Flow Pump Use in Different Phenotypes of Cardiogenic Shock – a Secondary Analysis of the DanGer Shock Trial

Resultado clave

Microaxial flow pump use reduced 180-day mortality with an odds ratio of 0.51 (95% CI 0.28-0.91, p=0.02) only in non-congested cardiogenic shock patients among myocardial infarction-related cardiogenic shock population.

Puntos clave

This analysis aims to evaluate the outcomes and trajectories of different cardiogenic shock phenotypes using microaxial flow pumps.
Patients from the DanGer Shock trial were categorized into three cardiogenic shock phenotypes: non-congested, cardiorenal, and cardiometabolic.
Missing phenotype data were addressed using multiple random forest imputation.
Outcomes assessed included 180-day mortality and clinical parameters over the first 72 hours, comparing mAFP to standard care.
In the trial, 41% of patients presented with non-congested, 11% with cardiorenal, and 48% with cardiometabolic phenotypes.
180-day mortality was highest in cardiometabolic CS (69%), followed by cardiorenal (47%) and non-congested CS (33%).
mAFP use significantly lowered mortality in the non-congested group (odds ratio: 0.51, p=0.02), while effects in other phenotypes were not statistically significant.

Diseño del estudio

Tipo

RCT (n=355)

Enmascaramiento

null

Aleatorización

randomized

Multicéntrico

Sí

PICO estructurado

Does microaxial flow pump use reduce 180-day mortality across different phenotypes of STEMI-related cardiogenic shock?

Población

355 adults aged 18 years or older presenting with ST-elevation myocardial infarction (STEMI) and cardiogenic shock (systolic blood pressure <100 mmHg or need for vasopressors, arterial lactate ≥2.5 mmol/L, and LVEF <45%). Excluded: coma following out-of-hospital cardiac arrest, advanced peripheral artery disease, or predominant right ventricular failure. Retrospectively assigned to non-congested (n=145), cardiorenal (n=38), or cardiometabolic (n=172) phenotypes.

Intervención

Microaxial flow pump (Impella CP) in combination with standard medical therapy

Comparador

Standard medical therapy alone

Resultado

180-day mortalityhard clinical

In a post-hoc analysis of the DanGer Shock trial, microaxial flow pumps showed the greatest apparent mortality benefit in the non-congested phenotype of cardiogenic shock, though the interaction across phenotypes was not statistically significant.

Resultado numérico

Estimación del efecto: OR 0.51 for non-congested CS, OR 0.81 for cardiometabolic CS, OR 0.91 for cardiorenal CS (95% CI 0.28-0.91 for non-congested CS, 0.57-1.16 for cardiometabolic CS, 0.35-2.34 for cardiorenal CS)

valor p: p=0.02 for non-congested CS, 0.25 for cardiometabolic CS, 0.84 for cardiorenal CS

Limitaciones

Post-hoc secondary analysis limiting causal inference
Univariable logistic regression without adjustment for potential confounders
Phenotype classification based on retrospective imputation
Exploratory analysis of clinical trajectories without p-values due to multiplicity

Resumen

AbstractBackground : Three cardiogenic shock (CS) phenotypes have been proposed and validated in various datasets: non-congested (I), cardiorenal (II), and cardiometabolic CS (III). The DanGer Shock trial demonstrated a mortality benefit of microaxial flow pump (mAFP) use in myocardial infarction-related CS. In this post-hoc analysis, we aimed to assess trajectories and outcomes of these phenotypes in the DanGer Shock population. Methods : Patients randomized in the DanGer Shock trial were retrospectively assigned to one of three CS phenotypes at admission. Missing values for phenotyping were imputed using multiple random forest imputation. Outcomes were 180-day mortality, and trajectories of key clinical, laboratory and hemodynamic parameters first 72 hours within phenotypes, stratified by allocation to mAFP or standard of care. Results : Out of 355 adult patients in the trial, 145 (41%), 38 (11%), and 172 (48%) patients were in the non-congested, cardiorenal, and cardiometabolic phenotypes, respectively. 180-day mortality was higher in cardiometabolic (69%) compared to non-congested (33%) and cardiorenal CS (47%). Clinical metabolic and hemodynamic trajectories and their treatment response differed between phenotypes. mAFP use was associated with lower mortality in non-congested CS (odds ratio: 0.51 0.28-0.91, p=0.02). The odds of mortality were 0.81 0.57-1.16 (p=0.25) in cardiometabolic and 0.91 0.35-2.34 (p=0.84) in cardiorenal CS (p for interaction: 0.43). Conclusion : In this post-hoc analysis of the DanGer Shock trial, predefined CS phenotypes showed distinct outcomes, with the non-congested phenotype faring best and the cardiometabolic worst. The greatest apparent benefit of mAFP was observed in non-congested CS. These findings are hypothesis-generating and warrant confirmation in prospective studies. Clinical Trial Registration : ClinicalTrials.gov unique identifier: NCT01633502. Condensed Abstract In this DanGer Shock post-hoc analysis, study participants were retrospectively assigned to one of three cardiogenic shock (CS) phenotypes: non-congested, cardiorenal, or cardiometabolic CS. 41%, 11%, and 48% of all 355 patients were in these phenotypes, respectively. 180-day mortality was higher in cardiometabolic (69%) compared to non-congested (33%) and cardiorenal CS (47%). mAFP use was associated with lower mortality in non-congested and numerically in cardiometabolic, but not in cardiorenal CS. In summary, CS phenotypes showed distinct outcomes, with the non-congested phenotype faring best and the cardiometabolic worst. The greatest apparent benefit of mAFP was observed in non-congested CS.

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Cite This Study

Zweck et al. (Sun,) conducted a rct in Adults with myocardial infarction-related cardiogenic shock classified into three phenotypes: non-congested, cardiorenal, and cardiometabolic (n=355). microaxial flow pump (mAFP) vs. standard of care was evaluated on 180-day all-cause mortality (OR 0.51 for non-congested CS, OR 0.81 for cardiometabolic CS, OR 0.91 for cardiorenal CS, 95% CI 0.28-0.91 for non-congested CS, 0.57-1.16 for cardiometabolic CS, 0.35-2.34 for cardiorenal CS, p=0.02 for non-congested CS, 0.25 for cardiometabolic CS, 0.84 for cardiorenal CS). Microaxial flow pump use reduced 180-day mortality with an odds ratio of 0.51 (95% CI 0.28-0.91, p=0.02) only in non-congested cardiogenic shock patients among myocardial infarction-related cardiogenic shock population.

synapsesocial.com/papers/69aa6eb1531e4c4a9ff58f56 https://doi.org/https://doi.org/10.1016/j.cardfail.2026.02.015

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