Acute Myocardial Infarction and Stage E Shock: Insights From the RECOVER III Study

Area of Science:

• Cardiology
• Interventional Cardiology
• Critical Care Medicine

Background:

• Acute myocardial infarction with cardiogenic shock (AMICS) is a critical condition.
• The Society of Cardiovascular Angiography & Interventions (SCAI) classification system stratifies shock severity.
• Impella support is utilized in advanced cardiogenic shock.

Purpose of the Study:

• To compare outcomes of SCAI stage E shock patients with AMICS treated with Impella.
• To identify predictors of response to Impella support in stage E AMICS patients.
• To evaluate the prognostic value of early reassessment of SCAI shock stage.

Main Methods:

• Analysis of RECOVER III trial data.
• Classification of patients into "responders" (improved from SCAI stage E to C/D within 24 hours of Impella) and "nonresponders" (remained stage E).
• Independent adjudication of SCAI shock stage by two reviewers, with a third for discrepancies.

Main Results:

• Of 298 stage E patients, 152 (51.1%) were responders and 145 (48.8%) were nonresponders.
• 30-day survival was significantly higher in responders (56.9%) versus nonresponders (28.6%) (P < .001).
• Predictors of responsiveness included fewer inotropic medications, more lesions treated, pre-PCI Impella initiation, and baseline white blood cell count.

Conclusions:

• Improvement in SCAI shock stage within 24 hours of Impella support is associated with significantly better survival in AMICS patients.
• Responsiveness predictors are primarily related to treatment strategy, not baseline characteristics.
• Repeating the SCAI shock stage within 24 hours of Impella initiation aids in accurate prognosis determination.