By Saadia Aslam
Higher Cardiogenic Shock Survival With NCSI Protocol: Final Results
Background
The National Cardiogenic Shock Initiative is a single-arm, prospective, multi-center study assessing outcomes associated with early mechanical circulatory support (MCS) in patients presenting with acute myocardial infarction and cardiogenic shock (AMICS) treated with percutaneous coronary intervention (PCI). (NCT03677180)
Methods
Between July 2016 and December 2020, 73 sites participated and enrolled into the study. All centres agreed to treat patients with AMICS using a standard protocol emphasising invasive hemodynamic monitoring and rapid initiation of MCS.
Results
A total of 406 patients were enrolled. Average age was 64±12 years, 24% were female and 67% were admitted in shock. 85% of patients were on vasopressors or inotropes, 17% had a witnessed out-of-hospital cardiac arrest, 27% had in-hospital cardiac arrest, and 9% were under active cardiopulmonary resuscitation during MCS implantation. 73% presented in SCAI stage C/D shock and 27% in stage E. Patients presented with an average blood pressure of 77/50, lactate of 4.8 mmol/dL and cardiac power output of 0.67W. In accordance with the protocol, 71% of patients had MCS implanted prior to PCI. Right heart catheterization was performed in 93%. 82% of patients presented with ST-elevation myocardial infarction with a median door to support time of 78 (IQR 54-116) mins and door to balloon time of 82 (IQR 57-114) min. Procedural survival, survival to discharge, survival to 30-days, and survival to 1-year were 99%, 79%, 77%, 62% for patients presenting in stage C/D shock and 98%, 49%, 46%, 32% for patients in stage E shock (p=0.01).
Conclusions
Early use of MCS and invasive hemodynamics is associated with improved outcomes. A randomized control trial evaluating the NCSI treatment strategy is warranted.
References
1: Baran DA, Grines CL, Bailey S, Burkhoff D, Hall SA, Henry TD, Hollenberg SM, Kapur NK, O’Neill W, Ornato JP, Stelling K, Thiele H, van Diepen S, Naidu SS. SCAI clinical expert consensus statement on the classification of cardiogenic shock: This document was endorsed by the American College of Cardiology (ACC), the American Heart Association (AHA), the Society of Critical Care Medicine (SCCM), and the Society of Thoracic Surgeons (STS) in April 2019. Catheter Cardiovasc Interv. 2019 Jul 1;94(1):29-37. doi: 10.1002/ccd.28329. Epub 2019 May 19. PMID: 31104355.
