Applying DanGer Shock Eligibility Criteria to a Real-World Cohort of Cardiogenic Shock Patients

BACKGROUND: The DanGer Shock trial investigated the effects of adding a microaxial flow pump to guideline-recommended therapy in patients with ST-elevation myocardial infarction (STEMI)-related cardiogenic shock (CS), finding a lower all-cause mortality at 180 days in the intervention group.

METHODS: DanGer Shock eligibility criteria were applied to the prospective single-center PREPARE CardShock registry, which consecutively enrolled 721 patients between April 2019 and August 2024 with advanced CS-classified as stages C to E according to the SCAI shock classification-who were on vasoactive medication and underwent cardiac catheterization.

RESULTS: Among 721 patients in the registry, 384 (53.3%) had STEMI-related CS. Of those, 117 (30.5%) met DanGer Shock trial eligibility criteria, accounting for 16.2% of the registry cohort. Median age of the eligible patients was 68 years (interquartile range [IQR]: 58-78), and 62.4% were male, compared to 68 years (IQR: 60-76) and 79.2% in DanGer Shock. PREPRARE-CS DanGer Shock eligible patients had a higher median systolic blood pressure (SBP) (92 mmHG [78-107] vs. 83 mmHG, [72-91]) and higher median lactate levels (5.2 mmol/L [3.6-7.6] vs. 4.6 mmol/L [3.3-7.0]) at baseline, and were more frequently resuscitated (56.4% vs. 20.3%). Device use was 42.7% in eligible patients. Renal replacement therapy (RRT) was more frequent among trial participants (34.4% vs. 17.1%). The 180-day mortality rate among eligible patients was 71.8%, compared to 52.1% in trial participants.

CONCLUSIONS: Among STEMI-related CS patients in our cohort, only one-third met the DanGer Shock eligibility criteria. Consequently, trial outcomes may not be broadly applicable.