"Acute Myocardial Infarction and Stage E Shock: Insights From the RECOV" by Ivan D. Hanson, Andres Palomo et al.
 

Acute Myocardial Infarction and Stage E Shock: Insights From the RECOVER III Study.

Document Type

Article

Publication Date

2-1-2025

Publication Title

Journal of the Society for Cardiovascular Angiography & Interventions

Abstract

BACKGROUND: The present analysis reports characteristics and outcomes of Society of Cardiovascular Angiography & Interventions (SCAI) stage E shock patients with acute myocardial infarction with cardiogenic shock (AMICS) undergoing percutaneous coronary intervention (PCI) who improved to stage C or D within 24 hours of Impella support ("responders") vs those patients who remained in stage E ("nonresponders").

METHODS: The SCAI shock stage was assigned prior to initiation of Impella, and a second SCAI shock classification was performed within 24 hours of Impella support. SCAI shock stage was assigned independently by 2 reviewers; in cases where there was a discrepancy, a third reviewer adjudicated the stage assignment. Criteria such as a low pH (≤7.1), the need for multiple vasopressors/mechanical circulatory support devices, or the need for cardiopulmonary resuscitation were used to define stage E shock.

RESULTS: Of the 415 RECOVER III patients, 298 presented in stage E shock; 152 (51.1%) were responders and 145 (48.8%) were nonresponders. Kaplan-Meier 30-day survival estimates were 56.9% and 28.6% in responders and nonresponders, respectively (

CONCLUSIONS: Stage E patients who improved to stage C/D within 24 hours of Impella support had significantly better survival than those who remained in stage E. Predictors of responsiveness to therapy were mostly related to shock treatment strategy, and not baseline characteristics. This suggests that whether stage E patients will improve with Impella support is difficult to determine at the time support is initiated, and the SCAI shock stage should be repeated within 24 hours to more accurately determine the prognosis.

Volume

4

Issue

2

First Page

102462

DOI

10.1016/j.jscai.2024.102462

ISSN

2772-9303

PubMed ID

40109709

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