Impact of Early Mechanical Support in Patients with Acute Myocardial Infarction Complicated by Cardiogenic Shock with Culprit Left Main Coronary Artery Disease: Insights from National Cardiogenic Shock Initiative

Jain, Tarun

Impact of Early Mechanical Support in Patients with Acute Myocardial Infarction Complicated by Cardiogenic Shock with Culprit Left Main Coronary Artery Disease: Insights from National Cardiogenic Shock Initiative

Monday, May 20, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Tarun Jain, M.B.B.S. , Henry Ford Health System, Detroit, MI

Alejandro Lemor, M.D. , Henry Ford Health System, Detroit, MI

Mir B. Basir, D.O., FSCAI , Henry Ford Health System, Detroit, MI

Navin K. Kapur, M.D., FSCAI , Tufts-New England Medical Center, Boston, MA

Theodore L. Schreiber, M.D., FSCAI , Cardiovascular Consultants, PC, Warren, MI

Amir Kaki, M.D., FSCAI, FSCAI , Lenox Hill Hospital, Birmingham, MI

Kiritkumar Patel , Cardiology and Vascular Assocs, Pontiac, MI

Charles E. Wilkins, M.D. , Montrose Memorial Hospital Cardiology, Farmington, NM

Shaun R. Senter, M.D., FSCAI , Walker Heart Institute CV Clinic, Fayetteville, AZ

Yasir Akhtar, M.B.B.S. , Tennova Healthcare, Knoxville, TN

David M Lasorda, D.O. , Allegheny General Hospital, Pittsburgh, PA

Malcolm Foster, Foster , Turkey Creek Medical Center, Knoxville, TN

Brian C Kolski, M.D. , OC Heart Institute, Orange, CA

Behnam N. Tehrani, M.D., FSCAI , INOVA Heart and Vascular Institute, Oakton, VA

Thomas A Lalonde, M.D. , St. John Hospital & Medical Center, Detriot, MI

Michael Green, Green , Northwest Medical Center, Springdale, AZ

John J. Finley, M.D., FSCAI , South Jersey Heart Group, Villanova, PA

Timothy J. Larkin, M.D. , Midwest Heart Specialists, Naperville, IL

Allison G. Dupont, M.D., FSCAI , The Heart Center of Northeast Georgia, Gainesville, GA

Brian O'Neill, M.D., FSCAI , Temple Interventional Heart & Vascular Institute, Philadephia, PA

David Mcallister, DO , Iowa Heat Center-W Des Moines, Des Moines, IA

Scott Martin, Martin , Stamford hospital, Stamford, CT

Steven P Marso, M.D. , Midwest Heart & Vascular Specialists, Kansas City, KS

Ivan Hanson, M.D., FSCAI , Beaumont Hospital, Troy, MI

Nimrod Blank, M.D. , Wayne State University/DMC, Detroit, MI

Tyrell Johnson, Johnson , Henry Ford Hospital, Detroit, MI

Michael Hacala , Henry Ford Hospital, Lake Orion, MI

William W. O'Neill , M.D., MSCAI , Henry Ford Hospital, Detroit, MI

Background:
Previous retrospective studies have demonstrated unacceptably high hospital mortality (60-65%) in patients presenting with acute myocardial infarction complicated by cardiogenic shock (AMICS) undergoing primary percutaneous coronary intervention (PCI) of a culprit left main coronary artery (LMCA). We sought to assess the impact of early mechanical support (MCS) specifically in this cohort using data from the National Cardiogenic Shock Initiative, a single-arm, prospective, multicenter study.

Methods:
Between July 2016 and August 2018, 23 sites participated in the study. All centers agreed to treat patients with AMICS using a standard protocol emphasizing invasive hemodynamic monitoring and rapid initiation of MCS. Inclusion and exclusion criteria mimicked those of the ‘SHOCK’ trial with an additional exclusion criteria being use of intra-aortic balloon pump counter-pulsation prior to MCS.

Results:
Out of a total of 104 patients enrolled, 16 patients had a culprit LMCA. In the culprit LMCA cohort, the mean age was 64 ± 11 years and 75% were males. Prior to MCS, 25% had witnessed out of hospital cardiac arrest, 25% had in-hospital cardiac arrest and 32% were under active cardiopulmonary resuscitation during MCS implantation. In accordance with the protocol, 87% of patients had a MCS device inserted prior to PCI. Right heart catheterization and hemodynamic monitoring was performed in 84% of patients. Cardiac power output improved from 0.68 W pre-procedure to 0.98 W 24-hours post-procedure (p = 0.04). TIMI III flow was achieved in 88% of patients post-reperfusion. Mean length of stay was 16 days. Left ventricle ejection fraction improved from 12.5 ± 3.8 % baseline to 25.6 ± 9.6 % at the time of discharge (p=0.002). Survival to explant was 94% and survival to discharge was 75%.

Conclusions:
Early MCS in patients with AMICS with a culprit LMCA was associated with rapid improvement in hemodynamics and improved survival to discharge.