Can Escalation Reduce Acute Myocardial Infarction Mortality in Cardiogenic Shock

Launched by HENRY FORD HEALTH SYSTEM · Mar 23, 2023

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ClinConnect Summary

The National Cardiogenic Shock Initiative (NCSI) was an initial step in helping to provide team based protocolized care in AMICS. Over the past 5 years, further evaluation and research has helped identify additional best practices that may contribute to further improving outcomes.

Vasopressors have been identified as being independently associated with worse outcomes and MCS escalation may lead to improvement. While sites participating in the NCSI were early adopters of MCS in AMICS, MCS escalation was open ended and dictated by variable local practice patterns. This contributed to the ove...

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Eligibility criteria

• Inclusion Criteria:
• • 1. Diagnosis of acute AMI confirmed by a medical professional, with changes in serum biomarkers or evidence of ischemic EKG changes (STEMI or NSTEMI).
• 2. Cardiogenic Shock present as defined by the presence of 2 OR MORE of the following criteria prior to PCI:
• • Hypotension: systolic blood pressure ≤ 90mmHg at baseline (prior to PCI) or the use of inotropes or vasopressors to maintain SBP ≥ 90mmHg
• • Evidence of end organ hypoperfusion: elevated serum lactate levels (venous or arterial), cool extremities, oliguria/anuria
• • Hemodynamic criteria: Cardiac Index of \< 2.2 L/min/m2 or a cardiac power output (CPO) of ≤ 0.6 watts
• • 3. Patient underwent PCI within 12 hours of hospital presentation.
• Exclusion Registry Exclusion Criteria:
• AMICS patients who meet any of the following study exclusion criteria will have a limited set of data collected via a single-page Patient Exclusion Form completed and submitted within 45 days of hospital discharge, which includes the reason for exclusion, date of index PCI, and assessment of patient survival to hospital discharge:
• • 1. Evidence of Anoxic Brain Injury
• • 2. Unwitnessed out of hospital cardiac arrest or any cardiac arrest in which return of spontaneous circulation (ROSC) is not achieved within 30 minutes
• • 3. IABP placed prior to MCS
• • 4. Septic, anaphylactic, hemorrhagic, and neurologic causes of shock
• • 5. Non-ischemic causes of shock/hypotension (pulmonary embolism, pneumothorax, myocarditis, tamponade, etc.)
• • 6. Active bleeding for which MCS is contraindicated
• • 7. Recent major surgery for which MCS is contraindicated
• • 8. Mechanical complications of AMI (acute ventricular septal defect (VSD) or acute papillary muscle rupture)
• • 9. Known left ventricular thrombus for which MCS is contraindicated
• • 10. Mechanical aortic prosthetic valve
• • 11. Contraindication to intravenous systemic anticoagulation which precludes placement of MCS.