Change of vasoactive-inotropic score in patients with cardiogenic shock receiving percutaneous ventricular assist device

Introduction The Vasoactive Inotropic Score (VIS), which quantifies the combined use of inotropes and vasopressors, has been shown to be an independent prognostic predictor in patients with cardiogenic shock (CS). However, the clinical significance of VIS used in patients with CS requiring percutaneous ventricular assist devices (PVADs) remains unclear. Purpose This study aimed to reveal the prognostic association between VIS change during the first 24-h device support and 30-day mortality in CS patients requiring PVADs. Methods A multicenter retrospective study (UNLOADERS-PVAD) was conducted on CS patients requiring PVADs. We excluded patients who died within 24-h post-PVAD or those without VIS assessment. Finally, 481 patients were included in this study. VIS was assessed at baseline (BL: pre PVAD) and at 24-h post PVAD. Patients were divided into 3 groups based on the BL-VIS as follows: the ‘BL-VIS = 0’ group (n=241); the ‘0< BL-VIS ≤20’ group (n=138); and the ‘BL-VIS >20’ group (n=102). The prognostic association between the change in VIS from BL to 24-h post-PVAD and 30-day in-hospital mortality was primarily evaluated. Results The median age was 70 years, with females comprising 26%. There were 277 patients who required venoarterial extracorporeal membrane oxygenation, and there was no significant difference in its concomitant usage among the 3 groups. The median BL-VIS was 0 [IQR: 0, 20] (0 20 group:33 [IQR: 27, 50]). In the ‘BL-VIS = 0’ group, the number of patients with acute coronary syndrome as the cause of shock was significantly higher, although the number of patients with severe heart failure was significantly lower than in the others. The number of patients with cardiac arrest and the lactate levels were significantly higher in the ‘BL-VIS = 0’ group. Of all, In-hospital mortality occurred in 157 patients (33%). The change of VIS during 24 hours showed a linear relationship with in-hospital mortality (Fig.1). There is no significant difference in risks of in-hospital mortality among BL-VIS group (Log-rank p=0.593), while patients with 24-h VIS change >+20 had significantly higher risks of in-hospital mortality (Log-rank p<0.001) (Fig. 2). Conclusions Early changes of VIS within 24-h post PVAD were associated with mortality risk in patients with CS. Patients with a significant increase of VIS (>+20) had worse outcome. Our results may serve an indicator for early patient stratification to optimize intervention in CS patients receiving PVAD.