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AMI-CS: bridge-to-recovery or bridge-to-advanced therapies - how long should we wait?
Session:
Sessão de Posters 23 - Choque cardiogénico: preditores, suporte e desfechos
Speaker:
Catarina Santos-Jorge
Congress:
CPC 2026
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
14. Acute Cardiac Care
Subtheme:
14.4 Acute Cardiac Care – Cardiogenic Shock
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
C. Santos-Jorge; André Garcia; Márcia Presume; Rui Gomes; Mariana Ramos; Ana Rita Bello; João Presume; Jorge Ferreira; Catarina Brizido
Abstract
<p><strong>Background:</strong><br /> Cardiogenic shock (CS) following acute myocardial infarction (AMI-CS) carries extremely high mortality despite advances in revascularization and short-term mechanical circulatory support (MCS). Progression to advanced heart failure (HF) requiring heart transplantation (HT) or durable left ventricular assist device (LVAD) represents the ultimate dismal outcome of refractory pump failure. We aimed to characterize AMI-CS clinical trajectory and identify predictors of transition to advanced HF therapies.</p> <p><strong>Methods:</strong><br /> Single-center, retrospective study including all consecutive patients admitted with AMI-CS between 2017-2025 to a cardiac intensive care unit. Patients >70 years were excluded, as they don’t comply with institutional criteria for advanced HF therapies. Data were collected at admission, day 5, and day 30. Although there is no defined timing to determine irreversibility of pump failure after MI, a 5-day deadline was used, as it is usually considered adequate to initiate advanced HF therapies evaluation at our institution. Patient status at 5 and 30 days was defined as recovered from CS, support-dependent (INTERMACS 3 or worse) or dead. Predictors of 30-day mortality and need for HT or LVAD during index admission or follow-up were obtained through univariate analysis.</p> <p><strong>Results:</strong><br /> From a total of 227 AMI-CS patients, 112 were included (mean age 59±10 years, 30% women). Most presented in SCAI stage C or D (n=85, 76%), and 24 (21%) with cardiac arrest. Median LVEF was 25% (20–35%) and MCS was required in 34 patients (31%). At day 5, 37 (33%) had recovered, 44 (38%) were support-dependent, and 31 (28%) had died. By day 30, 47 (42%) had recovered, 9 (8%) remained support-dependent, 50 (45%) had died and 6 (5%) underwent HT or LVAD. Among support-dependent patients at day 30, 4 underwent HT later during index hospitalization, one after discharge, and the remaining 4 died.</p> <p>Predictors of 30-day mortality included initial and day 5 SCAI stage (p=0.002), cardiac arrest (p=0.02) and ventricular dysfunction (p=0.016), particularly left ventricular and biventricular. The need for advanced HF therapies was predicted by MCS use (p=0.05), longer MCS duration (p=0.016), lower LVEF (p=0.038), support-dependent status at day 5 (p=0.03), and ongoing MCS at day 5 (p=0.03). The type of mechanical circulatory support influenced 30-day outcomes (p<0.001), as patients supported with IABP or Impella had better recovery and survival, while more complex MCS were linked to worse outcomes and higher likelihood of HT or LVAD.</p> <p><strong>Conclusions:</strong><br /> AMI-CS patients are a high-risk population with high mortality. Persistent hemodynamic instability, prolonged and complex MCS, and lower LVEF were the strongest predictors of need for advanced HF therapies. Early recognition of irreversible myocardial failure is essential to optimize referral and timing for LVAD or transplantation.</p>
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