Effect of microaxial flow pump on survival in isolated left main infarction related cardiogenic shock. A DanGer Shock substudy analysis
J Andersen, R P Beske, H Eiskjaer, N Mangner, A Polzin, P C Schulze, C Skurk, P Nordbeck, P Clemmensen, V Vanoulas, S Zimmer, A Schafer, C Hassager, J E Moller, T EngstroemAbstract
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.ESC Kaplan Meier