European Society of Cardiology: the 2023 Atlas of Cardiovascular Disease Statistics just published in #EHJ bit.ly/3X3A8Ga Rocco Montone EHJ Editor-in-Chief

Temporary mechanical circulatory support in infarct-related cardiogenic shock: an individual patient data meta-analysis of randomised trials with 6-month follow-up: The Lancet 🥸 "The use of MCS should be restricted to certain patients only" ~ Holger Thiele 😱 Summary 👇👇

🥸 1️⃣ Cardiogenic shock still has a high mortality rate, around 40-50%, despite medical advances. For AMI-related cariogenic shock, immediate revascularization is the only proven life-saving treatment.

🥸 2️⃣ Mechanical circulatory support (MCS) devices have become popular after studies showed intraaortic balloon pumps don't reduce mortality in cardiogenic shock.

🥸 3️⃣ Active MCS devices are classified into those that increase afterload (like VA-ECMO) and those that unload the heart (like microaxial flow pumps).

🥸 4️⃣ A large randomized trial comparing VA-ECMO with standard care found no mortality benefit but increased complications at 30 days. See Figure 1. Lancet 2023; 402: 1338–46. N Engl J Med 2023; 389: 1286–97.

🥸 5️⃣ Earlier trials on left ventricular unloading devices were limited and showed no mortality benefit, but a new large trial showed a 6-month survival benefit in specific patients.

🥸 6️⃣ This study conducted a meta-analysis combining data from several trials to determine the effects of early MCS use in AMI-related cardiogenic shock.

🥸 7️⃣ The primary finding: using MCS devices early did not reduce 6-month all-cause mortality in patients with infarct-related cardiogenic shock.

🥸 8️⃣ The mortality was probably reduced in patients with ST-elevation myocardial infarction who did not have a high risk of brain injury. 😱 May be -

🥸 9️⃣ The type of MCS device—whether loading or unloading the left ventricle—did not influence overall survival rates at 6 months. This was consistent across studies.

🥸 🔟 However, using MCS devices, regardless of type, led to more bleeding and vascular complications, including moderate to severe bleeding. 😱 21% bleeding 😱 3.2% stroke 😱 6% Ischemic complications 😱 Renal replacement 22%

🥸 1️⃣1️⃣ Patients receiving MCS were more likely to experience strokes and peripheral vascular complications compared to those receiving standard care. 😱 Yes - see above!!!

🥸 1️⃣2️⃣ For patients with STEMI and low risk of hypoxic brain injury, MCS showed a survival benefit, reducing mortality by approximately 10%. 😱Also HR 0.77 (95% CI 0.61-0.97)

🥸 1️⃣3️⃣ In the overall population, though, MCS did not lower 6-month mortality; patient selection is key to achieving better outcomes and all comers might not benefit.

🚨Verfolgen Sie hier den #Livestream! In wenigen Minuten geht es los: Die wichtigsten Neuigkeiten zum #ESCCongress der European Society of Cardiology vom #LeipzigerKardiologengespräch. 📅 Mi, 04. Sept 2024 | 19:00 - 20:30 Uhr | Livestream 📺 herzmedizin.de/kongress-updat… #Herzmedizinde #DGK #BNK

Kongress-Update #ESCCongress jetzt auf ⁦Herzmedizin.de⁩ aus ⁦Stadt Leipzig⁩ ⁦UNIVERSITÄT LEIPZIG⁩ ⁦Universitätsklinikum Leipzig⁩ ⁦Janine Pöss⁩ ⁦Mohamed Abdel-Wahab⁩

Alle News vom #ESCCongress der @ European Society of Cardiology im ESC-Update mit Prof. Holger Thiele und Prof. Laufs et al. Das On Demand-Video ist ab sofort verfügbar. 📺 herzmedizin.de/fuer-aerzte-un… Janine Pöss #Herzmedizinde #DGK #BNK

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