{"id":138496,"date":"2024-09-05T17:18:14","date_gmt":"2024-09-05T21:18:14","guid":{"rendered":"https:\/\/cardiologynownews.org\/?p=138496"},"modified":"2024-09-05T17:18:14","modified_gmt":"2024-09-05T21:18:14","slug":"ecls-shock-at-one-year-ecmo-does-not-reduce-mortality-in-acute-mi-related-cardiogenic-shock","status":"publish","type":"post","link":"https:\/\/cardiologynownews.org\/?p=138496","title":{"rendered":"ECLS-SHOCK: At One Year, ECMO Does Not Reduce Mortality in Acute MI-Related Cardiogenic Shock"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">Key Points:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">The 30-day ECLS SHOCK study demonstrated no benefit to up-front ECLS in the reduction of 30-day mortality in acute, infarct-related cardiogenic shock.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">At one year, there were similarly no differences in the primary endpoint of all-cause mortality between ECLS and control. Additionally, there were no differences in the secondary outcomes of CV mortality, readmissions, and repeat revascularization.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Patients receiving ECLS had significantly higher moderate or extreme pain at one year relative to those in the control arm, with no differences in other quality of life measures.<\/span><\/li>\n<\/ul>\n<p><!--more--><\/p>\n<p><span style=\"font-weight: 400;\">While cardiogenic shock mortality has not improved over the past decade, utilization of VA-ECMO and other forms of extracorporeal life support (ECLS) has increased rapidly. The 30-day results of ECLS SHOCK cast doubt on the up-front utilization of ECLS in acute-MI-related cardiogenic shock. In a breaking presentation at the 2024 ESC Congress today, Dr. Steffen Desch and his team presented \u201cExtracorporeal life support for acute myocardial infarction complicated by cardiogenic shock &#8211; 12 months results of the ECLS-SHOCK trial.\u201d\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The ECLS-SHOCK study (<\/span><a href=\"https:\/\/classic.clinicaltrials.gov\/ct2\/show\/NCT03637205\"><span style=\"font-weight: 400;\">NCT03637205<\/span><\/a><span style=\"font-weight: 400;\">) was a randomized, multicenter trial of patients with acute MI and cardiogenic shock treated with either up-front ECLS or randomized to the control arm. Participants were required to have cardiogenic shock complicating an acute MI with the addition of a) planned revascularization, b) sBP &lt;90mm Hg or catecholamines required to maintain a sBP&gt;90mm Hg,\u00a0 c) signs of impaired organ perfusion, and d) arterial lactate &gt; 3mmol\/L. Key exclusion criteria were resuscitation lasting &gt;45 minutes, onset of shock &gt;12 hours ago, a mechanical cause of shock, severe PAD precluding cannulation, and severe concomitant disease with a limited life expectancy &lt; 6 months. The primary endpoint was 30-day all-cause mortality.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">A total of 420 patients were 1:1 randomized to ECLS or control.\u00a0 The mean age was 62, 19% were women, and 67% presented with a STEMI. The median ejection fraction was 30%, and half presented in SCAI C shock. In keeping with the 30-day results, participants receiving ECLS had no difference in the primary endpoint of all-cause mortality at one year (HR 0.94, 95% CI 0.73-1.22). There were also no significant differences in myocardial reinfarction, CV mortality, repeat revascularization, rehospitalization for HF, or poor neurological outcomes amongst survivors (all p&gt;0.05). Quality of life was similar between groups, with no significant differences in mobility, self-care, usual activities, or anxiety\/depression between groups (p&gt;0.05); however, individuals who had received ECLS were more likely to have pain\/discomfort at one year (7.2% vs 3.7% for extreme pain and 31.3% vs 17.1% for moderate pain; p =0.013).\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">When discussing the clinical implications of the study at the ESC Dr. Desch stated: \u201cAt one year follow-up, ECLS therapy does not provide clinical benefit compared to optimal medical therapy alone in patients with severe infarct-related cardiogenic shock.\u201d\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Key Points: The 30-day ECLS SHOCK study demonstrated no benefit to up-front ECLS in the reduction of 30-day mortality in acute, infarct-related cardiogenic shock. At one year, there were similarly no differences in the primary endpoint of all-cause mortality between ECLS and control. Additionally, there were no differences in the secondary outcomes of CV mortality, [&hellip;]<\/p>\n","protected":false},"author":40603,"featured_media":18229,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[892,8],"tags":[45,893,47,185],"ppma_author":[1029],"class_list":{"0":"post-138496","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-esc-2024","8":"category-news","9":"tag-conference","10":"tag-esc-2024","11":"tag-featured","12":"tag-news","13":"author-leah-kosyakovsky"},"authors":[{"term_id":1029,"user_id":40603,"is_guest":0,"slug":"leah-kosyakovsky","display_name":"Leah Kosyakovsky","avatar_url":"https:\/\/secure.gravatar.com\/avatar\/864bde69f6f1f80e91e4a97f0a0ba8daa64c2bb702be09ed787444c7dfa045bb?s=96&r=g","0":null,"1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":""}],"_links":{"self":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/138496","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/users\/40603"}],"replies":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=138496"}],"version-history":[{"count":1,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/138496\/revisions"}],"predecessor-version":[{"id":138497,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/138496\/revisions\/138497"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/media\/18229"}],"wp:attachment":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=138496"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=138496"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=138496"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fppma_author&post=138496"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}