Dynamic Invasive Hemodynamic Congestion Profile Impacts Acute Myocardial Infarction Complicated by Cardiogenic Shock Outcomes: A Real-World Single-Center Study

Ortega-Hernandez, J A; González‐Pacheco, Héctor; Gopar‐Nieto, Rodrigo; Cruz, J L Briseno De La; Sierra-Lara, Daniel; Araiza-Garaygordobil, Diego; Eid-Lidt, Guering; Mendoza-García, Salvador; Manzur‐Sandoval, Daniel; Altamirano-Castillo, Alfredo; Ontiveros-Mercado, Heriberto; Aguilar-Montaño, Kladyer Melissa; Rosas-Martínez, Manuel; Hernández-Montfort, Jaime; Arias-Mendoza, Alexandra

doi:10.1016/j.cardfail.2022.10.425

Cited by 8 publications

(7 citation statements)

References 11 publications

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“…Lower PAPi levels in MOF suggest that these patients had an overall worse RV function, which is also supported by the fact that these patients had more RV congestion, as seen by higher RAP levels [ 15 ]. Therefore, as proposed previously [ 4 ], an effective rapid decongestion is paramount to avoiding MOF.…”

Section: Discussionmentioning

confidence: 95%

“…We classified the patients according to the 2022 SCAI stage, with the worst stage at 24 h after a PAC was installed [ 1 ]. We created a congestion profile for all patients using the standardized cut-off values [ 6 ] of pulmonary capillary wedge pressure (PCWP, ≥18 mmHg) and right atrial pressure (RAP, ≥12 mmHg), and we used the changes in these congestion profiles to categorize the patients into 3 groups: decongestive, neutral, or congestive within the first 24 h [ 1 , 2 , 4 ] (See Full Description in the Supplementary Data ).…”

Section: Methodsmentioning

confidence: 99%

“…Although SCAI 2022 provides an abstract form of measuring severity, the presence of organ involvement in the phenotyping process must be included. Also, dynamic congestion is paramount in AMI-CS outcomes [ 4 ]. Furthermore, hemodynamic trajectories must be studied because much of the information used to classify patients is single-point data, rather than with repeated measures [ 2 , 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Invasive Phenoprofiling of Acute-Myocardial-Infarction-Related Cardiogenic Shock

Ortega-Hernández,

González-Pacheco,

Argüello-Bolaños

et al. 2023

JCM

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Background: Studies had previously identified three cardiogenic shock (CS) phenotypes (cardiac-only, cardiorenal, and cardiometabolic). Therefore, we aimed to understand better the hemodynamic profiles of these phenotypes in acute myocardial infarction-CS (AMI-CS) using pulmonary artery catheter (PAC) data to better understand the AMI-CS heterogeneity. Methods: We analyzed the PAC data of 309 patients with AMI-CS. The patients were classified by SCAI shock stage, congestion profile, and phenotype. In addition, 24 h hemodynamic PAC data were obtained. Results: We identified three AMI-CS phenotypes: cardiac-only (43.7%), cardiorenal (32.0%), and cardiometabolic (24.3%). The cardiometabolic phenotype had the highest mortality rate (70.7%), followed by the cardiorenal (52.5%) and cardiac-only (33.3%) phenotypes, with significant differences (p < 0.001). Right atrial pressure (p = 0.001) and pulmonary capillary wedge pressure (p = 0.01) were higher in the cardiometabolic and cardiorenal phenotypes. Cardiac output, index, power, power index, and cardiac power index normalized by right atrial pressure and left-ventricular stroke work index were lower in the cardiorenal and cardiometabolic than in the cardiac-only phenotypes. We found a hazard ratio (HR) of 2.1 for the cardiorenal and 3.3 for cardiometabolic versus the cardiac-only phenotypes (p < 0.001). Also, multi-organ failure, acute kidney injury, and ventricular tachycardia/fibrillation had a significant HR. Multivariate analysis revealed that CS phenotypes retained significance (p < 0.001) when adjusted for the Society for Cardiovascular Angiography & Interventions score (p = 0.011) and ∆congestion (p = 0.028). These scores independently predicted mortality. Conclusions: Accurate patient prognosis and treatment strategies are crucial, and phenotyping in AMI-CS can aid in this effort. PAC profiling can provide valuable prognostic information and help design new trials involving AMI-CS.

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Section: Discussionmentioning

confidence: 95%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Invasive Phenoprofiling of Acute-Myocardial-Infarction-Related Cardiogenic Shock

Ortega-Hernández,

González-Pacheco,

Argüello-Bolaños

et al. 2023

JCM

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“…While prior proposals have discouraged PAC use, they are based upon data from noncontemporary cohorts compromised largely of patients with non-CS acute decompensated heart failure [18]. In contrast, more recent observational studies continue to demonstrate increased utilization of PAC and association between PAC and reduced mortality [19 ▪▪ ,20]. Furthermore, findings from the Cardiogenic Shock Working Group have shown that patients with early and complete hemodynamic profiling using PAC will are more likely to experience improved survival despite advanced severity of illness (SCAI E) [21 ▪ ].…”

Section: Cardiogenic Shock Detection and Classificationmentioning

confidence: 99%

Update on cardiogenic shock: from detection to team management

Khariton

Hassan

Hernández-Montfort

2023

Current Opinion in Cardiology

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Purpose of reviewThe following review is intended to provide a summary of contemporary cardiogenic shock (CS) profiling and diagnostic strategies, including biomarker and hemodynamic-based (invasive and noninvasive) monitoring, discuss clinical differences in presentation and trajectory between acute myocardial infarction (AMI)-CS and heart failure (HF)-CS, describe transitions to native heart recovery and heart replacement therapies with a focus on tailored management and emerging real-world data, and emphasize trends in team-based initiatives and interventions for cardiogenic shock including the integration of protocol-driven care. Recent findingsThis document provides a broad overview of contemporary scientific consensus statements as well as data derived from randomized controlled clinical trials and observational registry working groups focused on cardiogenic shock management.

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“…We also agree that non-recognized factors like the healthcare system, especially in our country, the late presentation, and the characteristic of our center (reference tertiary center) (2) may influence cardiogenic shock outcomes, giving higher mortality than Europe or United States (3–5). Our research team is committed to addressing this issue, particularly in acute myocardial infarction (AMI)–related cardiogenic shock (6,7).…”

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confidence: 99%

Beyond One-Size-Fits-All: Exploring Predictive Models for Cardiogenic Shock

Ortega-Hernandez¹,

González‐Pacheco

2023

Shock

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Dear Dr. Valiente Fernández and colleagues: We would like to express our gratitude for your interest in our work titled "Comparison of the Predictive Performance of Cardiogenic Shock Scores in a Real-World Latin America Country" (1) and for taking the time to provide insightful comments and feedback.Cardiogenic shock is often viewed as a "one-size-fits-all" homogeneous condition, but it can result from various etiologies and lead to significant morbidity and mortality. Therefore, accurate predictive models are essential for effective resource allocation in critical care. However, no scoring system is perfect, and clinical judgment must be exercised at the bedside.Prior studies have shown that some predictors, such as age, blood pressure, and vasopressor use, are readily quantifiable, while others, such as medication adherence and social status, are more complex. We also agree that non-recognized factors like the healthcare system, especially in our country, the late presentation, and the characteristic of our center (reference tertiary center) (2) may influence cardiogenic shock outcomes, giving higher mortality than Europe or United States (3-5). Our research team is committed to addressing this issue, particularly in acute myocardial infarction (AMI)-related cardiogenic shock (6,7).Regarding the U-shaped pattern observed in Figure 2 of our study, we would like to clarify that as we stratified the data by AMI and non-AMI, we found two different conclusions: non-AMI cardiogenic shock had a rollercoaster-shaped AUC, indicating that the models could identify the most severe cases at the outset, followed by a drop, with subsequent improvement driven by complications of the CS episode rather than CS itself. In contrast, the AUC variations in AMI-related cardiogenic shock were minimal. We agree that the differences observed in predictive performance based on the etiology of cardiogenic shock are essential to consider in the clinical setting.Specifically, CS scores have a better prediction ability than non-CS scores (GWTG-HF and ADHERE). We observed that CARDSHOCK, SCAI, and IABPSHOCK-II had the best prognostic information, which can help us promptly provide mechanical circulatory support (MCS). Furthermore, our study has also demonstrated that the etiology of CS matters, and we expect different behaviors to be seen in AMI versus non-AMI etiologies. As shown in Figure 2, there are some hidden nuances and clues for predictions in this figure, that is, if a patient with a non-AMI CS etiology arrives at our unit and we have to quickly decide on futility (<72 hours), the best score system would be SCAI or CARDSHOCK. On the other hand, for intermediate-term mortality (7 days), CARDSHOCK or SCAI may be more informative than IABPSHOCK-II scores to aid us in our decision.The roadmap from the ER➔CCU/ICU➔floor➔discharge is a long one to lower the impact of CS, and we are only just begging to carve the first steps ( 8), but the first steps are crucial in defining etiology, and choosing the best stratifications could allow us to a...

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Dynamic Invasive Hemodynamic Congestion Profile Impacts Acute Myocardial Infarction Complicated by Cardiogenic Shock Outcomes: A Real-World Single-Center Study

Cited by 8 publications

References 11 publications

Invasive Phenoprofiling of Acute-Myocardial-Infarction-Related Cardiogenic Shock

Invasive Phenoprofiling of Acute-Myocardial-Infarction-Related Cardiogenic Shock

Update on cardiogenic shock: from detection to team management

Beyond One-Size-Fits-All: Exploring Predictive Models for Cardiogenic Shock

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