Background: Cardiogenic shock (CS) is the most common cause of death in patients hospitalized with acute myocardial infarction (AMI). Despite immediate revascularization and increased use of pharmacological and mechanical circulatory support (MCS), CS mortality rates are still approaching 40–50% according to recent registries and randomized trials. Previous studies have demonstrated that left ventricular end-diastolic pressure (LVEDP) is an independent predictor of in-hospital and longer-term cardiovascular outcomes in patients with AMI. However, data is lacking in the literature regarding the prognostic impact of LVEDP across acute myocardial infarction complicated by cardiogenic shock (AMICS). We sought to determine the impact of the baseline LVEDP on in-hospital mortality and cerebrovascular events (MACCE) in patients with AMICS, who received Impella during hospitalization.

Methods and results: Between 2017 and 2019 a total of 27 patients with AMICS underwent emergent high-risk PCI with Impella support (mean age 69 years, 78% male). LVEDP was measured in all cases before Impella insertion and start of PCI. The Impella MCS was placed in all cases during the index PCI procedure. In 5 cases an additional extracorporeal life support was implanted during intensive care unit (ICU) stay.  The duration of Impella support was 1.6 ± 0.9 days and the mean length of stay on the intensive care unit was 12 days. The in-hospital MACCE rate was 37% with 10 deaths during ICU stay. Preprocedural measured LVEDP was 23 ± 11 mmHg. Comparing the survivor with the non-survivors, a significant higher LVEDP was observed in the non-survivor group (19±7 mmHg vs. 31±13mmHg; p=<0.005). The other variables showed no differences. 

Conclusion: In patients presenting with cardiogenic shock, a high baseline LVEDP was associated with a higher rate of in-hospital MACCE. LVEDP could therefore be an additional stratification method for the identification of patients, who are at higher risk for in-hospital MACCE.