OR02-1
Treatment of Acute Myocardial Infarction and Cardiogenic Shock: Outcomes of the RECOVER III Post-Approval Study in SCAI SHOCK Stage E Patients
Presenter
Ivan Hanson, M.D., FSCAI, Beaumont Hospital - Royal Oak, Troy, MI
Ivan Hanson, M.D., FSCAI1, Simon R. Dixon, MBChB2, Adam M Tawney, MD, FSCAI2, Andres P Palomo, MD, FSCAI2, Srihari S. Naidu, MD3, Babar B Basir, DO, FSCAI4 and William W. O'Neill, MD, MSCAI4, (1)Beaumont Hospital - Royal Oak, Troy, MI, (2)Corewell Health William Beaumont University Hospital, Royal Oak, MI, (3)Westchester Medical Center, New York, NY, (4)Henry Ford Health System, Detroit, MI
Keywords: Acute Coronary Syndromes (ACS), Cardiogenic Shock and Hemodynamic Support
Background
RECOVER III is an observational, prospective, multicenter, single-arm, FDA-audited post-approval study of the Impella device in patients presenting with acute myocardial infarction and cardiogenic shock undergoing PCI. Overall results of RECOVER III have been previously reported. We now report characteristics and outcomes of SCAI stage E patients who improved to stage C or D within 24 hours of Impella support (“Responders”) versus those patients who remained in stage E (“Non-Responders”).
Methods
SCAI SHOCK stage was assigned at presentation, and a second SCAI SHOCK classification was performed within 24 hours of Impella support. SCAI shock stage was assigned by two independent reviewers; in the rare cases in which a discrepant stage was assigned, a third independent reviewer adjudicated stage assignment. Criteria such as a low pH (≤7.2), the need for multiple vasopressors/MCS devices, or the need for cardiopulmonary resuscitation, were used to define stage E shock.
Results
Of 415 RECOVER III patients, 298 presented in stage E shock; 152 (51.1%) were Responders and 145 (48.8%) were Non-Responders. Responders were treated with fewer inotropic medications pre-Impella (2.0 versus 2.5, p<0.0001) and during Impella (1.4 versus 3.0; p<0.0001). Responders had more lesions treated than Non-Responders (2.1 versus 1.7, p=0.009). In-hospital mortality was 53% amongst the overall stage E subgroup; 38% in Responders and 69% in Non-responders (p<0.0001). In multivariate analysis, fewer inotropic medications during Impella support (p<0.0001), more lesions treated (p=0.01), Impella support initiated pre-PCI (p=0.03), and baseline WBC (p=0.048) were all significant predictors for Responsiveness to therapy.
Conclusions
Stage E patients who improved to stage C/D within 24 hours of Impella support had significantly more favorable survival than those who remained in stage E. There were several predictors of responsiveness to therapy; most related to shock treatment strategy. This suggests that whether stage E patients will improve with Impella support may be difficult to determine at the time support is initiated, and SCAI shock stage should be repeated within 24 hours to more accurately determine prognosis.