(P037) QUANTIFYING THE NEED FOR MICROAXIAL-FLOW PUMP IN STEMI SHOCK PATIENTS: DATA FROM A LARGE CANADIAN QUATERNARY CENTER

Background: Cardiogenic shock in patients with ST-Elevation MI (STEMI) confers a mortality of up to 50% . The recent DanGer trial, using a strategy of temporary mechanical circulatory support with a microaxial-flow pump, was associated with an absolute reduction in mortality of 12.7%. Notable is the highly selective nature of the patients included in the trial and the substantial resources required, including devices and lengthened hospital and intensive care stays. To determine the possible implications of undertaking a DanGer strategy, we performed a retrospective analysis to determine the potential volume of patients in a large Canadian quaternary cardiac referral center.

METHODS AND RESULTS: We performed an analysis using the University of Ottawa Heart Institute’s primary percutaneous coronary intervention (PCI) STEMI database. The database includes all primary PCI patients who presented with a STEMI between 2004-2017. Of 5904 patients, 334 were initially identified as having possible cardiogenic shock based on the original IAPB-SHOCK II criteria (see figure). Inclusion and exclusion criteria from DanGer were retrospectively applied to the cohort, specifically to determine lactate levels, LV ejection fractions, presence of coma following out-of-hospital cardiac arrest, severe right ventricular dysfunction, mechanical complications, and other criteria as outlined in the study. Patients were categorized as “definite” DanGer candidates if complete data supported inclusion in the DanGer trial. Patients with missing data on presenting lactate or LV assessment but otherwise supportive data were classified as “likely” candidates. All other patients, including those with exclusion criteria, were considered non-candidates. Exclusions are shown in figure 1. Overall, 114 patients (1.93% of STEMI patients or 34.13% of those with cardiogenic shock) would qualify for a DanGer strategy. Baseline demographics and clinical outcomes of the groups are shown in Table 1.

Conclusion: Our retrospective analysis of a primary PCI cohort indicates only a small proportion ( < 2%) of patients presenting with a STEMI would qualify for a DanGer strategy. Further data is required to better quantify and describe this population nationwide and determine full cost implications.