Key points are not available for this paper at this time.
This editorial refers to ‘Short-term survival of dual SGLT2i-MRA and four-class guideline-directed medical therapy in acute heart failure’, by J. Bruno et al., https://doi.org/10.1093/ejhf/xuag218. Despite early revascularization, advances in intensive care, and increasing access to temporary mechanical circulatory support (tMCS), mortality rates in acute myocardial infarction complicated by cardiogenic shock (AMI-CS) remain unacceptably high. The main hurdle in choosing the optimal therapeutic approach for AMI-CS patients is due to their broad heterogeneity, as some die despite maximal support, some require early escalation to tMCS to survive, and others recover rapidly after reperfusion and short-term haemodynamic stabilization. At admission, distinguishing between these expected trajectories may have better prognostic implications than just deciding upon the preferred tMCS. The Research Letter by Buske and colleagues, ‘Predicting fast recovery in infarct-related cardiogenic shock—Insights from the ECLS-SHOCK trial’, is timely. Rather than asking again whether routine extracorporeal life support (ECLS) improves survival, the authors focus on a more refined clinical question: ‘to identify AMI-CS patients with intrinsic potential for rapid recovery’. In this post hoc exploratory analysis of ECLS-SHOCK, early recovery was defined as discharge alive from the intensive care unit (ICU) within 5 days of randomization, with survival for at least 7 days outside the ICU. Early recovery occurred in only 29 of 417 patients (7.0%) and was almost identical in the ECLS and in the control groups (6.7% vs. 7.2%). Patients with early recovery had lower lactate levels, higher pH, less prior cardiopulmonary resuscitation, shorter catecholamine exposure, and earlier haemodynamic stabilization. Their prognosis was strikingly different: 30-day mortality was 3.4% versus 51.8% in patients without early recovery, and 12-month mortality was 3.4% versus 59.3%.1 Low pre-PCI lactate was independently associated with early recovery, whereas age was not.1
Avraham et al. (Fri,) studied this question.