Advertisement

Dynamic Invasive Hemodynamic Congestion Profile Impacts Acute Myocardial Infarction Complicated by Cardiogenic Shock Outcomes: A Real-World Single-Center Study

Published:November 04, 2022DOI:https://doi.org/10.1016/j.cardfail.2022.10.425

      Highlights

      • Persistent or new congestion within the first 24 hours of cardiogenic shock is associated with worse outcomes.
      • BiV or persistent congestion and higher SCAI stages are associated with worsening hemodynamics.
      • Incorporating hemodynamic and congestion assessment plus SCAI stages in AMI-CS could potentially impact clinical outcomes by optimizing guideline-directed therapies.

      ABSTRACT

      Background

      Cardiogenic shock (CS) commonly complicates the management of acute myocardial infarction (AMI), and it results in high mortality rates. Pulmonary artery catheter (PAC) monitoring can be valuable for personalizing critical-care interventions. We hypothesized that patients with AMI-CS experiencing persistent congestion measures during the first 24 hours of the PAC installment would exhibit worse in-hospital survival rates.

      Methods and Results

      We studied 95 patients with AMI-CS between January 2006 and December 2021. The first 24-hour PAC-derived hemodynamic measures were divided by the congestion profiling and the proposed 2022 Cardiovascular Angiography and Interventions (SCAI) classification. Biventricular congestion was the most common profile and was associated with the highest patient mortality rates at all time points (mean 56.6%). A persistent congestive profile was associated with increased mortality rates (hazard ratio [HR] = 1.85; P = 0.002) compared with patients who achieved decongestive profiles. Patients with SCAI stages D/E had higher levels of right atrial pressure (RAP): 14–15 mmHg) and pulmonary capillary wedge pressure (PCWP): 18–20 mmHg) compared with stage C (RAP, 10–11 mmHg, mean difference 3–5 mmHg; P < 0.001; PCWP 14–17 mmHg; mean difference 1.56–4 mmHg; P = 0.011). In SCAI stages D/E, the pulmonary artery pulsatility index (0.8–1.19) was lower than in those with grade C (1.29–1.63; mean difference 0.21–0.73; P < 0.001).

      Conclusions

      Continuous congestion profiling using the SCAI classification matched the grade of hemodynamic severity and the increased risk of in-hospital death. Early decongestion appears to be an important prognostic and therapeutic goal in patients with AMI-CS and warrants further study.

      Graphical Abstract

      Image, graphical abstract
      Graphical AbstractDynamic Invasive Hemodynamic Congestion Profile Impacts Acute Myocardial Infarction Complicated by Cardiogenic Shock Outcomes. In AMI-CS the first 24 hours of hemodynamic monitoring after PAC placement demonstrated that patients with persistent or new congestion (red line) had a higher overall mortality. SCAI stages D and E had worse hemodynamic profiles and higher mortality rates in AMI-CS.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Cardiac Failure
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Hunziker L
        • Radovanovic D
        • Jeger R
        • Pedrazzini G
        • Cuculi F
        • Urban P
        • et al.
        Twenty-year trends in the incidence and outcome of cardiogenic shock in AMIS plus registry.
        Circ Cardiovasc Interv. 2019; 12https://doi.org/10.1161/CIRCINTERVENTIONS.118.007293
        • De Luca L
        • Olivari Z
        • Farina A
        • Gonzini L
        • Lucci D
        • Di Chiara A
        • et al.
        Temporal trends in the epidemiology, management, and outcome of patients with cardiogenic shock complicating acute coronary syndromes.
        Eur J Heart Fail. 2015; 17: 1124-1132https://doi.org/10.1002/EJHF.339
        • González-Pacheco H
        • Manzur-Sandoval D
        • Gopar-Nieto R
        • Álvarez-Sangabriel A
        • Martínez-Sánchez C
        • Eid-Lidt G
        • et al.
        Cardiogenic shock among patients with and without acute myocardial infarction in a Latin American country: a single-institution study.
        Glob Heart. 2021; 16https://doi.org/10.5334/GH.988
        • Naidu SS
        • Baran DA
        • Jentzer JC
        • Hollenberg SM
        • van Diepen S
        • Basir MB
        • et al.
        SCAI SHOCK stage classification expert consensus update: a review and incorporation of validation studies.
        J Am Coll Cardiol. 2022; https://doi.org/10.1016/j.jacc.2022.01.018
        • Thayer KL
        • Zweck E
        • Ayouty M
        • Garan AR
        • Hernandez-Montfort J
        • Mahr C
        • et al.
        Invasive hemodynamic assessment and classification of in-hospital mortality risk among patients with cardiogenic shock.
        Circ Heart Fail. 2020; 13e007099https://doi.org/10.1161/CIRCHEARTFAILURE.120.007099
        • Jentzer JC
        • van Diepen S
        • Barsness GW
        • Henry TD
        • Menon V
        • Rihal CS
        • et al.
        Cardiogenic shock classification to predict mortality in the cardiac intensive care unit.
        J Am Coll Cardiol. 2019; 74: 2117-2128https://doi.org/10.1016/J.JACC.2019.07.077
        • Garan AR
        • Kanwar M
        • Thayer KL
        • Whitehead E
        • Zweck E
        • Hernandez-Montfort J
        • et al.
        Complete hemodynamic profiling with pulmonary artery catheters in cardiogenic shock is associated with lower in-hospital mortality.
        JACC Hear Fail. 2020; 8: 903-913
        • Randhawa VK
        • Al-Fares A
        • Tong MZY
        • Soltesz EG
        • Hernandez-Montfort J
        • Taimeh Z
        • et al.
        A pragmatic approach to weaning temporary mechanical circulatory support: a state-of-the-art review.
        JACC Heart Fail. 2021; 9: 664-673https://doi.org/10.1016/J.JCHF.2021.05.011/SUPPL_FILE/MMC1.DOCX
        • Jain P
        • Thayer KL
        • Abraham J
        • Everett KD
        • Pahuja M
        • Whitehead EH
        • et al.
        Right ventricular dysfunction is common and identifies patients at risk of dying in cardiogenic shock.
        J Card Fail. 2021; 27: 1061-1072https://doi.org/10.1016/j.cardfail.2021.07.013
        • Cooper LB
        • Mentz RJ
        • Stevens SR
        • Felker GM
        • Lombardi C
        • Metra M
        • et al.
        Hemodynamic predictors of heart failure morbidity and mortality: fluid or flow?.
        J Card Fail. 2016; 22: 182-189https://doi.org/10.1016/J.CARDFAIL.2015.11.012
        • Lala A
        • Guo Y
        • Xu J
        • Esposito M
        • Morine K
        • Karas R
        • et al.
        Right ventricular dysfunction in acute myocardial infarction complicated by cardiogenic shock: a hemodynamic analysis of the Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock (SHOCK) trial and registry.
        J Card Fail. 2018; 24: 148-156https://doi.org/10.1016/J.CARDFAIL.2017.10.009