Pragmatic DanGer Shock Eligibility, Outcomes, and Costs in Acute Myocardial Infarction
Key result
pDanGer eligibility is linked to ~42% lower in-hospital mortality among AMI patients on MCS.
- aOR 0.58
- 95% CI 0.47-0.73
- n=2,226
Why the study?
In-hospital mortality remains high in AMI-related cardiogenic shock despite advances in MCS, suggesting not all patients benefit.
Does pDanGer eligibility predict lower in-hospital mortality in AMI patients treated with MCS?
Study Design
Type
Cohort (n=2,226)
Multicenter
Yes
Structured PICO
Does pDanGer eligibility predict lower in-hospital mortality in AMI patients treated with MCS?
P
Population
2,226 patients with acute myocardial infarction treated with mechanical circulatory support in Japan, followed for a median of 11 days.
E
Exposure
pDanGer eligibility (defined by the absence of mechanical complications, out-of-hospital cardiac arrest with persistent coma, and severe dementia)
C
Comparator
pDanGer ineligibility
O
Outcome
In-hospital mortalityhard clinical
Main Result
Odds Ratio: 0.58 (95% CI 0.47–0.73)
Applying DanGer Shock trial eligibility criteria pragmatically identifies AMI patients treated with MCS who have lower in-hospital mortality and better discharge outcomes, highlighting its utility for patient selection.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“The long-term data from the DanGer Shock RCT released today validates the original findings and confirms that the survival benefit of Impella CP is durable and increases year-over-year.”
“we wanted to see if the Impella device was as good if the patients came late as when they came early.”
Implication
Supports pDanGer eligibility for risk stratification in AMI with MCS; leaves open prospective validation of device selection criteria.
Abstract
BACKGROUND: In-hospital mortality remains 45% among patients with acute myocardial infarction (AMI)-related cardiogenic shock despite advances in mechanical circulatory support (MCS), including microaxial flow pumps and venoarterial extracorporeal membrane oxygenation. These findings suggest that not all patients benefit from MCS. OBJECTIVES: This study aimed to identify patients less likely to benefit from MCS based on pragmatically approximated Danish-German Cardiogenic Shock trial (pDanGer) eligibility. METHODS: Using a Japanese nationwide administrative dataset (JROAD-DPC [Japanese Registry Of All cardiac and vascular Diseases-Diagnostic Procedure Combination]) from 2022 to 2023, we evaluated the association of pDanGer eligibility with in-hospital mortality, failure to be discharged home, and medical costs; pDanGer eligibility was defined by the absence of mechanical complications, out-of-hospital cardiac arrest with persistent coma, and severe dementia. RESULTS: Of 52,927 AMI patients, 2,226 were treated with MCS. Among them, in-hospital death and failure to be discharged home were identified in 1,339 (pDanGer-eligible, 945; ineligible, 394) and in 379 (pDanGer-eligible, 281; ineligible, 98), respectively. The median follow-up was 11 days (IQR: 8-16). pDanGer eligibility was associated with lower in-hospital mortality (adjusted OR [aOR]: 0.58; 95% CI: 0.47-0.73) and lower failure to be discharged home (aOR: 0.37; 95% CI: 0.25-0.54). Medical costs were higher in pDanGer-ineligible survivors and those discharged home, while among patients who died, costs were higher in pDanGer-eligible patients. CONCLUSIONS: pDanGer eligibility was associated with lower in-hospital mortality and failure to be discharged home among AMI patients treated with MCS. In contrast, ineligible patients incurred substantial medical costs, highlighting the importance of appropriate patient selection for MCS use.
Discussion
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Cite This Study
Higuchi et al. (2026) conducted a cohort in Acute myocardial infarction with cardiogenic shock treated with mechanical circulatory support (n=2,226). pDanGer eligibility vs. pDanGer-ineligible was evaluated on In-hospital mortality (aOR 0.58, 95% CI 0.47-0.73). Among AMI patients treated with mechanical circulatory support, pDanGer eligibility was associated with lower in-hospital mortality (aOR 0.58; 95% CI 0.47-0.73).