Mangner Norman, Mierke Johannes, Baron Dominik, Woitek Felix J, Haussig Stephan, Nowack Thomas, Winzer Ephraim B, Fischer Julia, Höllriegel Robert, Jellinghaus Stefanie, Linke Axel
Department for Internal Medicine and Cardiology, Heart Centre Dresden, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany.
ESC Heart Fail. 2025 Aug;12(4):2759-2768. doi: 10.1002/ehf2.15269. Epub 2025 Mar 19.
The DanGer Shock (DGS) trial demonstrated that the routine use of a microaxial flow pump (mAFP) with standard care to treat STEMI-related cardiogenic shock (STEMI-CS) led to a lower risk of all-cause death at 180 days than standard care alone. We investigated the impact of patient eligibility for DGS in an all-comers cardiogenic shock registry of patients receiving a mAFP.
Prospective single-centre mAFP registry including 478 CS-patients with 225 patients having STEMI-CS. DGS-like was defined as STEMI-CS, lactate ≥2.5 mmol/L, left ventricular ejection fraction < 45%, no mechanical complications, and no comatose out-of-hospital cardiac arrest but in-hospital cardiac arrest with a maximum of 10 min to return of spontaneous circulation as a surrogate for medically witnessed cardiac arrest was included. The comparison group consisted of STEMI-CS patients who did not fulfil the aforementioned criteria (DGS-unlike). The primary outcome was 180-day mortality. Out of 225 STEMI-CS, 64 (28.4%) patients were considered DGS-like. Those patients were younger, had less often received CPR before mAFP implantation, and mAFP-support was longer. Comorbidities, baseline lactate, coronary artery disease characteristics/treatment, inotropes/vasopressors, and escalation to other mechanical circulatory support devices were not different. All-cause mortality at 180 days was significantly lower in the DGS-like compared to the DGS-unlike cohort (62.5% vs. 72.0%, P = 0.014) as was 30-day all-cause mortality (48.4% vs. 70.2%, P < 0.001). DGS-like remained an independent predictor of both 180-day (HR 0.57, 95% CI 0.39, 0.83) and 30-day mortality (HR 0.48, 95% CI 0.32, 0.72) in a multivariable analysis.
A DGS-like profile was associated with a lower 180-day mortality compared with a DGS-unlike profile in a STEMI-CS cohort treated by mAFP.
“危险休克”（DGS）试验表明，在治疗ST段抬高型心肌梗死相关的心源性休克（STEMI-CS）时，常规使用微轴流泵（mAFP）联合标准治疗，与单纯标准治疗相比，180天时全因死亡风险更低。我们在一个接受mAFP治疗的所有心源性休克患者登记处，研究了符合DGS标准的患者情况的影响。
前瞻性单中心mAFP登记处纳入了478例心源性休克患者，其中225例为STEMI-CS患者。类似DGS的情况定义为STEMI-CS、乳酸水平≥2.5 mmol/L、左心室射血分数<45%、无机械并发症、无院外心脏骤停昏迷但有院内心脏骤停且自主循环恢复时间最长为10分钟，将其作为医学见证心脏骤停的替代情况纳入。对照组由不符合上述标准的STEMI-CS患者（非类似DGS情况）组成。主要结局是180天死亡率。在225例STEMI-CS患者中，64例（28.4%）被认为类似DGS情况。这些患者更年轻，在植入mAFP前接受心肺复苏的情况较少，且mAFP支持时间更长。合并症、基线乳酸水平、冠状动脉疾病特征/治疗、血管活性药物使用情况以及升级使用其他机械循环支持设备的情况并无差异。与非类似DGS队列相比，类似DGS队列180天的全因死亡率显著更低（62.5%对72.0%，P = 0.014），30天全因死亡率也是如此（48.4%对70.2%，P < 0.001）。在多变量分析中，类似DGS情况仍然是180天（风险比0.57，95%置信区间0.39，0.83）和30天死亡率（风险比0.48，95%置信区间0.32，0.72）的独立预测因素。
在接受mAFP治疗的STEMI-CS队列中，与非类似DGS情况相比，类似DGS情况与更低的180天死亡率相关。
