Protocolised Management of Acute Myocardial Infarction Complicated by Cardiogenic Shock in Australia-Initial...

Acute myocardial infarction complicated by cardiogenic shock (AMICS) confers short-term mortality of 40%-50%. Protocolised network management of AMICS patients as part of a hub-and-spoke model supported by upstream mechanical circulatory support (MCS) is gaining traction globally to treat AMICS.

We conducted a prospective multicenter study in Melbourne, Australia describing our 5-year experience utilizing a protocolised hub-and-spoke model of care for patients with AMICS supported by planned upstream use of Impella CP (Abiomed, Danvers, MA).

From December 2019 to August 2024, 31 patients were treated for AMICS with Impella MCS support. Median age was 60 years and 87% were males. ST-elevation myocardial infarction accounted for 84% of presentations, and 29% were complicated by cardiac arrest. The majority of patients treated were in SCAI-CSWG stage D (52%), and stage C (26%) shock. Upstream Impella prior to PCI occurred in 84% of patients. The 30-day survival rate was 74%. An adverse event occurred in 39% of patients. Device-related complications were due to hemolysis (32%) and arrhythmia (3%). Escalation of MCS support was required in five patients (16%). Multivariate analysis identified patients requiring transfer to the hub center prior to revascularisation as an independent predictor of mortality (OR 13.2 [1.34-129.3] p = 0.027).

In this first protocolised hub-and-spoke model of care for AMICS supported by planned upstream use of Impella in Australia, 30-day survival was high compared to published historical rates. Patient and device-related complication rates were low. Expansion of the hub-and-spoke model for the treatment of AMICS appears warranted.