{
  "abstract": "Introduction Cardiogenic shock in the context of acute myocardial infarction (MI) carries persistently high mortality despite advances in revascularisation and critical care. Mechanical circulatory support with the Impella CP device provides active left ventricular unloading and haemodynamic support, and the DanGer Shock trial demonstrated a significant mortality benefit (absolute risk reduction 12.7%, NNT≈8) in carefully selected patients. Hammersmith Hospital is a high-volume tertiary cardiac centre where Impella is not currently available. This audit aimed to determine how many patients labelled as cardiogenic shock would have met DanGer eligibility and to describe their outcomes.Methods A single-centre retrospective review was performed using cases labelled in the electronic record as ‘cardiogenic shock’ between November 2024 and October 2020. Electronic records were used to extract demographic, clinical and haemodynamic data. Each case was assessed against DanGer inclusion criteria (STEMI/STEMI-equivalent, lactate ≥2.5 mmol/L or SvO 2<55%, LVEF<45% without isolated RV failure, SBP<100 mmHg or vasopressors, and presence of a PCI target) and exclusion criteria (neurological devastation, major aortic pathology or mechanical valve, LV thrombus, isolated RV shock, non-cardiogenic shock, or no PCI target). Patients were stratified into Impella-eligible vs ineligible groups. Outcomes included 30-day mortality, SCAI grade and key haemodynamic variables.Results Thirty-two patients were included; seven (22%) met full DanGer eligibility. Exclusions were most commonly due to neurological impairment, isolated RV shock, absence of a PCI target, or significant aortic/valvular disease. Overall, 30-day mortality was 65%. Mortality was 57.1% in the eligible group vs 70.8% in the ineligible group (Fisher’s p=0.65; OR 0.55), a non-significant difference. Eligible patients showed the haemodynamic phenotype expected by DanGer, with significantly higher lactate (p=0.020) and a trend toward lower SBP. SCAI grading was advanced across the cohort, with 28/32 (88%) classified as C/D/E. Two additional patients would have qualified if the lactate threshold was lowered to >2.0 mmol/L.Conclusion Cardiogenic shock, in the context of acute MI, at our centre remained associated with very high mortality. A substantial minority (22%) met DanGer eligibility, representing seven patients in one year who might have derived benefit from Impella (NNT≈8). Despite limitations including small sample size, retrospective design and reliance on cath-lab coding, this audit identifies a clear Impella-eligible phenotype and highlights a potential unmet need for early mechanical circulatory support.",
  "authors": [
    {
      "affiliations": [
        "Imperial College London NHS Trust, London, United Kingdom"
      ],
      "name": "Isaac Harris"
    },
    {
      "affiliations": [
        "Imperial College London NHS Trust, London, United Kingdom"
      ],
      "name": "Christopher Baker"
    }
  ],
  "title": "188 Identifying impella-eligible patients with cardiogenic shock secondary to acute MI using DanGer shock criteria: a single-centre retrospective review",
  "uid": "27c8087f-bad3-5d56-8ff0-d4393a25284c"
}