Related Experiment Video
Updated: Jun 5, 2025
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Perspectives on why DanGer Shock is the first positive trial on mechanical circulatory support in cardiogenic shock
Giulio M Mondellini1, Antoon J M van den Enden1, Nicolas M Van Mieghem2
1Department of Interventional Cardiology, Cardiovascular Institute, Erasmus University Medical Center Rotterdam, Office Nt-645, Dr. Molewaterplein 40, Thoraxcenter, Rotterdam, 3015 GD, The Netherlands.
Insights
The DanGer Shock trial demonstrated mechanical circulatory support (MCS) benefits for acute myocardial infarction with cardiogenic shock (AMI-CS). Specific patient selection, early MCS deployment, and intensive care protocols were key to this success.
Area of Science:
- Cardiology
- Interventional Cardiology
- Critical Care Medicine
Background:
- Acute myocardial infarction with cardiogenic shock (AMI-CS) has high mortality despite advances in treatment.
- Previous randomized controlled trials (RCTs) have not shown benefit for mechanical circulatory support (MCS) in AMI-CS.
- The DanGer Shock trial offers a novel approach to managing AMI-CS.
Purpose of the Study:
- To identify key features contributing to the success of the DanGer Shock trial.
- To understand why this trial was the first to demonstrate a benefit for MCS in AMI-CS.
- To inform future trial design and clinical practice for AMI-CS management.
Main Methods:
- Systematic review of contemporary randomized controlled trials for AMI-CS.
- Analysis of trial design elements, including patient selection, timing of intervention, and management protocols.
- Comparison of the DanGer Shock trial's methodology with previous negative trials.
Main Results:
- The DanGer Shock trial identified four critical features for successful MCS in AMI-CS.
- These features include specific patient phenotypes (STEMI, excluding severe RV failure/coma), early MCS deployment before revascularization, and rigorous intensive care protocols.
- These distinct elements likely explain the positive outcomes observed in the DanGer Shock trial.
Conclusions:
- The DanGer Shock trial represents a breakthrough in managing AMI-CS with MCS.
- Optimal patient selection, timely MCS intervention, and comprehensive critical care are crucial for improving outcomes.
- These findings necessitate a re-evaluation of MCS strategies in AMI-CS.
Abstract:
Cardiogenic shock related to acute myocardial infarction (AMI-CS) remains a severe condition associated with a high risk of mortality despite increased availability of primary percutaneous coronary intervention and improvements in pharmacologic and device-based therapy. The results of the DanGer Shock trial stand out compared with the outcomes of the previous trials and mark the first mechanical circulatory support (MCS) strategy to show a benefit in patients with AMI-CS, a population that has always been challenging to study. Notably, negative findings from previous trials may mask positive treatment effects in specific subgroups and patient category. We systematically reviewed the design of all contemporary randomized controlled AMI-CS trials and identified four distinct features, which likely provide reasons why DanGer Shock became the first positive randomized controlled trial to support MCS in AMI-CS. DanGer Shock was the first RCT that established MCS in the context of AMI-CS. Key features were (1) patient phenotype that 1) includes STEMI and 2) excludes severe RV failure and persistent comatose state after out-of-hospital cardiac arrest; (3) optimal timing of MCS deployment, as soon as possible (lower SCAI stage) and before revascularization efforts; and (4) rigorous intensive care management protocols on hemodynamic and MCS monitoring.
