Can Escalation Reduce Acute myocardial infarction Mortality In Cardiogenic Shock (CERAMICS)
Presenter
Babar B Basir, DO, FSCAI, Henry Ford Health System, Detroit, MI
Babar B Basir, DO, FSCAI, Henry Ford Health System, Detroit, MI, Mohan Brar, MD, St. Elizabeth Physicians, Cedar Rapids, IA, Brian C Kolski, MD, OC Heart Institute, Orange, CA, Joshua W. Todd, M.D., FSCAI, Knoxville Heart Group, Knoxville, TN, Allison G. Dupont, M.D., FSCAI, Northside Hospital Heart Institute, Lawrenceville, GA, Amir Kaki, M.D., FSCAI, Henry Ford St. John Hospital, Birmingham, MI, Kirit Patel, MD, Trinity Health Oakland, Pontiac, MI, India, Dr. Aditya Mehra, M.D., FSCAI, Hackensack Meridian Ocean University Medical Center, Brick, NJ, David H Wohns, M.D., FSCAI, Corewell Health/Michigan State, Grand Rapids, MI, David M. Lasorda, D.O., FSCAI, Allegheny Health Network , Pittsburgh, PA, Nainesh C. Patel, M.D., FSCAI, Lehigh Valley Health Network, Allentown, PA, Dr. Aditya Bharadwaj, M.B.B.S., FSCAI, University of Miami Miller School of Medicine, Miami, FL, Ann Gage, M.D., TriStar Centennial Medical Center, Nashville, TN, Nandish K. Thukral, M.D., FSCAI, Methodist Cardiology Clinic of San Antonio, San Antonio, TX, Ali Nsair, MD, Ronald Reagan UCLA Medical Center, Los Angeles, CA, Santiago Garcia, MD, FSCAI, The Christ Hospital Health Network, Cincinnati, OH, Nima Aghili, M.D., Colorado Heart and Vascular, Lakewood, CO, Ayaz Rahman, MD, Parkwest, Knoxsville, TN, Angela Taylor, M.D., The University of Virginia, Charlottesville, VA, Ramesh Mazhari, M.D., FSCAI, George Washington University, Washington, DC and William W. O'Neill, MD, MSCAI, Henry Ford Health System, Orchard Lake, MI
Keywords: Acute Coronary Syndromes (ACS), Cardiogenic Shock, Complex and High-risk Coronary Intervention (CHIP), Heart Failure and Hemodynamic Support
Background:
The CERAMICS study (NCT05800951) is a single-arm, multi-center study assessing outcomes associated with early use of Impella in patients presenting with AMI-CS treated with PCI in shock centers with the ability to perform MCS escalation.
Methods:
Between Nov 2022 - Nov 2025, 20 sites participated in the study. All centers agreed to treat patients with AMI-CS using a standard protocol emphasizing invasive hemodynamic monitoring and rapid initiation of Impella with as needed MCS escalation.
Results:
A total of 124 patients were enrolled. Average age was 66±11 years, 30% were female and 83% were admitted in shock. Vasoactive agents were used in 77% of patients during the index procedure, 12% had a witnessed out-of-hospital cardiac arrest, 34% had in-hospital cardiac arrest, and 2% were under active cardiopulmonary resuscitation during MCS implantation. Patients presented with an average blood pressure of 76/51, lactate of 5.4 mmol/dL, cardiac power output of 0.71W; 64% presented in SCAI stage C/D shock and 36% in stage E. . In accordance with the protocol, 68% of patients had MCS implanted prior to PCI and pulmonary artery catheters were utilized in 95%. STEMI occurred in 89% of patients presented with a median door to support time of 76 (IQR 61-114) mins and door to balloon time of 72 (IQR 54-111) mins. Survival to discharge was 71% in the entire cohort, 78% in stage C/D shock, and 60% in stage E shock. MCS escalation was performed in 23% of patients who had an overall in-hospital survival of 57%; 43% underwent escalation with Impella 5.5 (n=12) and had a survival of 58%; and 36% with ECMO (n=10) with a survival of 70%. Advanced heart failure therapies were used in 4.8%. Blood transfusion was required in 47%, acute kidney injury occurred in 52%, 21% required in-hospital dialysis and 9% of survivors required dialysis after discharge.
Conclusions:
In centers with MCS escalation capabilities, early use of MCS and invasive hemodynamics was associated with favorable outcomes, although similar to previous reports from the NCSI. Focusing on early shock recognition and delivery of guideline recommended therapies including Impella and PCI in PCI capable hospitals should remain the focus of care in patients presenting with AMI-CS.