This study analyzed 106 patients with CS and Impella® support between 2015 and 2018. Non-ischemic CS was seen in 36 patients, and AMI-related CS was seen in 70 patients. The non-ischemic group was the younger group compared to the AMI group. The non-ischemic group had more patients with severely reduced left ventricular function with a worse glomerular filtration rate. Based on propensity score matching, 31 patients were identified with non-ischemic CS, and 31 patients with AMI-related CS were identified with no difference in baseline laboratory values or comorbidities. Percutaneous VAD support was given along with hemodynamic stabilization in both groups. Within seven days, the following changes were observed in both groups: 

SBP levels: 

Non-ischemic CS group: Increased from 91mmHg to 100mmHg. 

AMI-related CS group: Increased from 89 mmHg to 112 mmHg. 

The need for catecholamines (calculated as vasoactive-inotropic score): 

Non-ischemic CS group: Decreased from 32.0 to 5.3  

AMI-related CS group: Decreased from 35.2 to zero 

Lactate levels: 

Non-ischemic CS group: Reduced from 3.8 to 1.0 mmol/L. 

AMI-related CS group: Reduced from 3.8 to 1.2 mmol/L. 

In the non-ischemic group, around eight patients upgraded to veno-arterial extracorporeal membrane oxygenation (VA-ECMO) or long-term mechanical circulatory support. Of them, two patients received heart transplants. In the AMI group, eight patients upgraded to VA-ECMO or long-term mechanical circulatory support. The survival rate of 90 days showed no difference between the groups (non-ischemic CS group 48.4%, AMI-related CS group 45.2%). 

Conclusion: 

Along with acting as a valuable bridge to patients' recovery or long-term left ventricular support and heart transplantation, pVAD support can be used for hemodynamic stabilization in non-ischemic CS patients. 

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Keywords

Disease Condition,Therapeutic Modality,Coronary Artery Disease,Myocardial Infarction ,Myocardial Disease and Cardiomyopathies,Interventional Cardiology,Cardiogenic Shock,Percutaneous Coronary Intervention

Source

https://onlinelibrary.wiley.com/doi/full/10.1002/ehf2.13546