Key result
Microaxial flow pump cuts 180-day mortality ~57% vs standard care.
Why the study?
Isolated left main occlusion in STEMI complicated by cardiogenic shock is a distinct high-risk phenotype with immediate global ischemic burden, and the specific effect of a microaxial flow pump versus standard care in this subgroup needed evaluation.
Does a microaxial flow pump reduce 180-day all-cause mortality compared to standard care in patients with STEMI-related cardiogenic shock and isolated left main occlusion?
RCT (n=35)
Randomized
Yes
Does a microaxial flow pump reduce 180-day all-cause mortality compared to standard care in patients with STEMI-related cardiogenic shock and isolated left main occlusion?
In an exploratory post-hoc substudy of the DanGer Shock trial, microaxial flow pump treatment was associated with higher 180-day survival compared to standard care in the high-risk subgroup of STEMI-related cardiogenic shock patients with isolated left main occlusion.
Microaxial flow pump may benefit left main STEMI-CS; extends DanGer Shock findings to this high-risk subgroup.
Background Isolated left main (LM) occlusion in ST-segment elevation myocardial infarction complicated by cardiogenic shock (STEMI-CS) represents a distinct and particularly high-risk phenotype, characterized by abrupt loss of perfusion to a large myocardial territory. Unlike patients with multivessel disease—where residual perfusion and collaterals may influence hemodynamics—isolated LM occlusion results in immediate, global ischemic burden. Purpose To evaluate the effect of microaxial flow pump (mAFP) vs. standard care in STEMI-CS patients with isolated LM occlusion. Methods This is a substudy of the multicenter, randomized DanGer shock trial investigating STEMI-CS patients. Baseline characteristics include data on diseased coronary vessels. Dividing patients into single vessel and multivessel disease groups, with isolated LM occlusion also classified as multivessel disease. The primary endpoint was all-cause mortality at 180 days. Hazard ratios were estimated in in the intention-to-treat (ITT) population using Cox regression models. Results Of the 355 patients in the intention-to-treat population, 256 patients were recorded with multivessel disease. Isolated LM culprit was present in 35 patients. Baseline characteristics were comparable between the standard of care and mAFP groups. Median age was 71 (interquartile range (IQR): 64,77), and all 35 (100%) were men. Two (5.7%) patients had been resuscitated from out-of-hospital cardiac arrest. Median systolic blood pressure was 80 mm Hg (IQR 69, 90), left ventricular ejection fraction (LVEF) was 20 % (IQR: 15, 25) and lactate 4.70 mmol/L (IQR: 3.50, 8.00). All but two patients (94%) had ≥99% stenosis of the LM vessel. At 180 days survival was markedly higher in patients treated with mAFP compared to standard care 50.0% (26.9-73.1%) vs. 17.6% (0.0-35.8%) The unadjusted HR for all-cause mortality was 0.43 (95% CI 0.18 – 1.01). After adjusting for lactate, LVEF, and age, mAFP remained associated with lower mortality (Adjusted HR 0.34, 95% CI 0.14-0.87) Conclusion This exploratory post-hoc analysis suggests that mAFP treatment in STEMI-CS patients with isolated LM occlusion as the culprit lesion had a substantial benefit of mAFP.
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Andersen et al. (2026) conducted an RCT in ST-segment elevation myocardial infarction complicated by cardiogenic shock (STEMI-CS) with isolated left main occlusion (n=35). Microaxial flow pump (mAFP) vs. Standard care was evaluated on All-cause mortality at 180 days (HR 0.43, 95% CI 0.18-1.01). Microaxial flow pump improved 180-day survival vs standard care (50.0% vs 17.6%; unadjusted mortality HR 0.43, 95% CI 0.18-1.01; adjusted HR 0.34, 95% CI 0.14-0.87).
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