Key result
Vasoactive Inotropic Score >36 linked to ~289% greater risk of clinical deterioration vs lower scores.
Why the study?
Clinical deterioration is common after IABP in cardiogenic shock, leading to delayed mechanical circulatory support escalation and death, and predictors such as VIS might aid treatment decisions.
Does a higher Vasoactive Inotropic Score predict clinical deterioration in patients with cardiogenic shock undergoing intra-aortic balloon pumping?
Cohort (n=138)
No
Does a higher Vasoactive Inotropic Score predict clinical deterioration in patients with cardiogenic shock undergoing intra-aortic balloon pumping?
Hazard Ratio: 3.89 (95% CI 2.2–6.9)
Absolute Event Rate: 71% vs 23%
p-value: p=< 0.001
A Vasoactive Inotropic Score above 36 strongly predicts clinical deterioration, including mortality and need for mechanical circulatory support escalation, in patients with cardiogenic shock undergoing IABP.
Elevated VIS was associated with post-IABP deterioration; hypothesis-generating for risk stratification in cardiogenic shock.
Background: Cardiogenic shock (CS), a life-threatening condition with high morbidity, often requires mechanical circulatory support (MCS), such as intra-aortic balloon pumping (IABP). However, clinical deterioration is still common after IABP leading to delayed MCS escalation and death. The predictor of clinical deterioration such as Vasoactive Inotropic Scores (VIS) might be helpful in treatment decision. Method: We retrospectively studied prognostic value of VIS for clinical deterioration after IABP placement in CS patients in Siriraj Hospital during 2016 – 2021 period. The primary outcome was composition of death, MCS escalation, and orthotopic heart transplantation. VIS was calculated using the maximum dosing after IABP insertion. Results: A total of 138 CS patients who underwent IABP were enrolled. The average age was 66 years with 60% male. Acute coronary syndrome was the cause of CS in 75% of patients. The median VIS was 36. Clinical deterioration was observed in 65 patients (47%). Patients with VIS > median were significantly more likely to experience clinical deterioration,71% vs 23%, respectively (HR 3.89; 95% CI 2.2 - 6.9, P < 0.001). This included higher mortality (58% vs 20.3%, P < 0.001) and increased need for MCS (18.8% vs 1.5%, P = 0.001). Conclusion: VIS was a strong predictor of clinical deterioration in between CS patients undergoing IABP therapy. VIS can aid in timely fashioned management in these patients. Corresponding contact: Asst. Prof. Dr. Satit Janwanishstaporn
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Wanitphisitphan et al. (2026) conducted a cohort in Cardiogenic shock (n=138). Vasoactive Inotropic Score (VIS) > median (36) vs. Vasoactive Inotropic Score (VIS) ≤ median (36) was evaluated on Composition of death, MCS escalation, and orthotopic heart transplantation (clinical deterioration) (HR 3.89, 95% CI 2.2 - 6.9, p=< 0.001). A Vasoactive Inotropic Score >36 was associated with higher clinical deterioration (death, MCS escalation, or transplant) than lower scores (71% vs 23%; HR 3.89, 95% CI 2.2-6.9, P<0.001).
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