JAMA cardiology · 2025
Systolic Blood Pressure and Microaxial Flow Pump-Associated Survival in Infarct-Related Cardiogenic Shock: A Post Hoc Analysis of the DanGer Shock Randomized Clinical Trial.
СтатьяМногоцентровое исследованиеРандомизированное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Mikkelsen Astrid Duus, Beske Rasmus Paulin, Jensen Lisette Okkels, Eiskjær Hans, Mangner Norman, Polzin Amin, Schulze Christian, Skurk Carsten, Nordbeck Peter, Schrage Benedikt, Panoulas Vasileios, Zimmer Sebastian, Schäfer Andreas, Engstrøm Thomas, Holmvang Lene, Frydland Martin, Junker Anders Bo, Schmidt Henrik, Udesen Nanna Louise Junker, Wachtell Kristian, Terkelsen Christian Juhl, Linke Axel, Kjærgaard Jesper, Møller Jacob Eifer, Hassager Christian, DanGer Shock Investigators
Аннотация
IMPORTANCE: Microaxial flow pump treatment improves survival in selected patients with infarct-related cardiogenic shock; however, treatment carries substantial risks, and benefit may vary by patient subgroup. Systolic blood pressure (SBP) has been proposed as a modifier of the survival benefit.
OBJECTIVE: To investigate whether SBP at randomization modifies the survival benefit of microaxial flow pump treatment in ST-segment elevation myocardial infarction-related cardiogenic shock.
DESIGN, SETTING, AND PARTICIPANTS: This was a post hoc analysis of the Danish-German (DanGer) Shock open-label randomized clinical trial among adult patients with ST-segment elevation myocardial infarction complicated by cardiogenic shock, conducted between 2013 and 2023 at 14 tertiary invasive cardiac centers in Denmark, Germany, and the United Kingdom. Data analysis was performed from January 7 to April 7, 2024.
INTERVENTION: Microaxial flow pump therapy plus standard care vs standard care alone.
MAIN OUTCOMES AND MEASURES: All-cause mortality at 180 days according to randomization SBP.
RESULTS: Of 355 patients included in the DanGer Shock trial, 351 patients had available SBP at randomization (median [IQR] age, 69 [59-76] years; 277 [79%] male). In a dichotomized regression analysis, microaxial flow pump treatment significantly reduced mortality for SBPs lower than 82 mm Hg compared with standard care alone (odds ratio [OR], 0.34; 95% CI, 0.18-0.63; P < .001). This was not evident for higher pressures (OR, 0.96; 95% CI, 0.53-1.70; P = .90; P for interaction = .02). Kaplan-Meier survival analysis and spline regression analysis supported these findings (P for interaction = .02; P for nonlinearity = .01).
CONCLUSIONS AND RELEVANCE: Randomization SBP was associated with the survival benefit of microaxial flow pump treatment, with the most hypotensive patients deriving the largest survival benefit. Early SBP may help identify patients most likely to gain a net benefit from microaxial flow pump treatment. Findings are hypothesis generating.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01633502.
OBJECTIVE: To investigate whether SBP at randomization modifies the survival benefit of microaxial flow pump treatment in ST-segment elevation myocardial infarction-related cardiogenic shock.
DESIGN, SETTING, AND PARTICIPANTS: This was a post hoc analysis of the Danish-German (DanGer) Shock open-label randomized clinical trial among adult patients with ST-segment elevation myocardial infarction complicated by cardiogenic shock, conducted between 2013 and 2023 at 14 tertiary invasive cardiac centers in Denmark, Germany, and the United Kingdom. Data analysis was performed from January 7 to April 7, 2024.
INTERVENTION: Microaxial flow pump therapy plus standard care vs standard care alone.
MAIN OUTCOMES AND MEASURES: All-cause mortality at 180 days according to randomization SBP.
RESULTS: Of 355 patients included in the DanGer Shock trial, 351 patients had available SBP at randomization (median [IQR] age, 69 [59-76] years; 277 [79%] male). In a dichotomized regression analysis, microaxial flow pump treatment significantly reduced mortality for SBPs lower than 82 mm Hg compared with standard care alone (odds ratio [OR], 0.34; 95% CI, 0.18-0.63; P < .001). This was not evident for higher pressures (OR, 0.96; 95% CI, 0.53-1.70; P = .90; P for interaction = .02). Kaplan-Meier survival analysis and spline regression analysis supported these findings (P for interaction = .02; P for nonlinearity = .01).
CONCLUSIONS AND RELEVANCE: Randomization SBP was associated with the survival benefit of microaxial flow pump treatment, with the most hypotensive patients deriving the largest survival benefit. Early SBP may help identify patients most likely to gain a net benefit from microaxial flow pump treatment. Findings are hypothesis generating.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01633502.