Impact of DanGer Shock eligibility criteria on survival in patients with acute myocardial infarction-related cardiogenic shock: it is all about Impella?

Abstract Introduction The recently published DanGer Shock trial demonstrated that incorporating a microaxial flow pump (Impella) alongside standard care significantly reduced all-cause mortality at 180 days in patients with STEMI-related cardiogenic shock (CS) compared to standard care alone. It was the first randomized controlled trial to demonstrate a mortality benefit from any temporary mechanical circulatory support (MCS) device in cardiogenic shock (CS). However, variability in regional practices and differences in the prioritization of patient selection criteria across centers can challenge the direct applicability of clinical trial findings to real-world settings. We aim to investigate the proportion of patients with AMI-CS in a contemporary cardiac intensive care unit population in Portugal, that would meet major eligibility criteria for DanGer Shock, and evaluate differences in all-cause mortality at 180 days in eligible and ineligible groups. Methods Retrospective single-center study of AMI-CS adult patients admitted between January 2017 and September 2024. Baseline characteristics, patient severity, type of MCS used, and mortality at 30 and 180days were compared based on eligibility criteria for Danger Shock. Also Kaplan-Meier survival curves were estimated. Results Our cohort include 181 patients with AMI-CS of whom 85 met eligibility criteria for DanGer shock trial (See flow-chat). Eligible patients when compared to ineligible were more frequently submitted to PCI (88.2% vs 62.5%, p0,001) and implanted more MCS (52.9% vs 32.3%, p=0,005). The type of MCS used was similar in both groups (see Table 4). Mortality at 180 days was significantly lower in the eligible group (54.5% vs 77.7%, p=0,001). Kaplan Meier curves showed that the eligible group was significantly associated with a better mortality-free time (LogRank test, p0.001). Conclusion Patients meeting the eligibility criteria for the DanGer Shock trial demonstrated improved survival outcomes, independent of the type of MCS employed. These findings suggest that the positive results of the trial may be attributed to the stringent selection criteria, which were associated with higher rates of revascularization and increased MCS utilization, rather than being exclusively linked to the use of the Impella device.