DanGer Shock (secondary analysis)
Trial question
What is the role of microaxial flow pump in patients with STEMI-induced cardiogenic shock?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
21.0% female
79.0% male
N = 355
355 patients (74 female, 281 male).
Inclusion criteria: patients with STEMI-induced cardiogenic shock.
Key exclusion criteria: comatose state after out-of-hospital cardiac arrest; mechanical complication to ST-segment elevation MI; RV failure.
Interventions
N=179 microaxial flow pump (treatment with a catheter-based percutaneous transvalvular microaxial flow pump [Impella CP®] for a minimum of 48 hours).
N=176 standard care (treatment with conventional circulatory support and observed in ICU for a minimum of 48 hours).
Primary outcome
Acute kidney injury
61%
45%
61.0 %
45.8 %
30.5 %
15.3 %
0.0 %
Microaxial flow
pump
Standard
care
Significant
increase ▲
NNH = 6
Significant increase in AKI (61% vs. 45%; OR 1.96, 96% CI 1.29 to 3).
Secondary outcomes
Significant increase in RRT (42% vs. 27%; AD 15%, 95% CI 3.58 to 26.42).
Significant decrease in death at day 180 in patients with AKI (54% vs. 68%; OR 0.49, 95% CI 0.26 to 0.93).
Significant increase in median serum creatinine among survivors (127 mcmol/L vs. 100 mcmol/L; AD 27 mcmol/L, 95% CI 10.98 to 43.02).
Conclusion
In patients with STEMI-induced cardiogenic shock, microaxial flow pump was inferior to standard care with respect to AKI.
Reference
Nanna Louise Junker Udesen, Rasmus Paulin Beske, Christian Hassager et al. Microaxial Flow Pump Hemodynamic and Metabolic Effects in Infarct-Related Cardiogenic Shock: A Substudy of the DanGer Shock Randomized Clinical Trial. JAMA Cardiol. 2024 Oct 27:e244197.
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