Clinical Research & Data, AMI Cardiogenic Shock

Vasopressors Independently Associated with Mortality in AMICS

 

Babar Basir, DO, discusses his paper titled “Vasopressors independently associated with mortality in acute myocardial infarction and cardiogenic shock,” published in August 2021 issue of Catheterization & Cardiovascular Interventions. Dr. Basir is the director of acute mechanical circulatory support at Henry Ford Hospital in Detroit, MI.

Vasopressors and inotropes have been first-line therapy for cardiogenic shock for decades. “We’ve gone decades using these medications and not really improving outcomes and these medications are not without consequence,” Dr. Basir explains. “And so now that we have more robust hemodynamic support devices, we really ought to ask ourselves the question: what are we doing with these vasopressors and inotropes?”

The data in his paper is from a substudy of the National Cardiogenic Shock Initiative (NCSI) looking at patients after PCI and Impella® who are on 0 vasopressors, 1 vasopressor, or 2 or more vasopressors. “Basically, we looked at all of these patients and then we came to conclusion that vasopressors and inotropes were associated with worse mortality.”

Dr. Basir describes the central figure in the paper, depicting unadjusted estimated in-hospital mortality by cardiac power output (CPO) and vasopressor use in the 3 patient groups. “What it really shows you, for example, is that if you have a cardiac power output of 1 and you’re not on vasopressors and inotropes and you’re able to just use Impella as your hemodynamic support strategy, your mortality was less than 20%. If you had to use a vasopressor and inotrope, or use more than 1 vasopressor and inotrope, then your mortality significantly increased to over 40%.”

“These are always going to be really tricky patients,” Dr. Basir emphasizes, “but I think that when you have the ability to put in support and wean off the pressors as much as clinically possible, we think that is basically going to help these patients.”

Dr. Basir concludes by asking, “Is it riskier to put in the hemodynamic support or is it riskier to continue the patient on vasopressors and inotropes?” He then answers, “I think as we get smaller, more powerful devices, that is going to continue to sway in the direction of hemodynamic support.” He also expresses hope that there will soon be more prospective information from the RECOVER IV trial to help establish the best way of treating these patients going forward.

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