PMID- 37334659
OWN - NLM
STAT- MEDLINE
DCOM- 20230823
LR  - 20230823
IS  - 1969-6213 (Electronic)
IS  - 1774-024X (Print)
IS  - 1774-024X (Linking)
VI  - 19
IP  - 6
DP  - 2023 Aug 21
TI  - Venoarterial extracorporeal membrane oxygenation or standard care in patients 
      with cardiogenic shock complicating acute myocardial infarction: the multicentre, 
      randomised EURO SHOCK trial.
PG  - 482-492
LID - EIJ-D-23-00204 [pii]
LID - 10.4244/EIJ-D-23-00204 [doi]
AB  - BACKGROUND: Cardiogenic shock (CGS) occurs in 10% of patients presenting with 
      acute myocardial infarction (MI), with in-hospital mortality rates of 40-50% 
      despite revascularisation. AIMS: The EURO SHOCK trial aimed to determine if early 
      use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) could improve 
      outcomes in patients with persistent CGS following primary percutaneous coronary 
      intervention (PPCI). METHODS: This multicentre, pan-European trial randomised 
      patients with persistent CGS 30 minutes after PPCI of the culprit lesion to 
      receive either VA-ECMO or continue with standard therapy. The primary outcome 
      measure was 30-day all-cause mortality in an intention-to-treat analysis. 
      Secondary endpoints included 12-month all-cause mortality and 12-month composite 
      of all-cause mortality or rehospitalisation due to heart failure. RESULTS: Due to 
      the impact of the COVID-19 pandemic, the trial was stopped before completion of 
      recruitment, after randomisation of 35 patients (standard therapy n=18, VA-ECMO 
      n=17). Thirty-day all-cause mortality occurred in 43.8% of patients randomised to 
      VA-ECMO and in 61.1% of patients randomised to standard therapy (hazard ratio 
      [HR] 0.56, 95% confidence interval [CI]: 0.21-1.45; p=0.22). One-year all-cause 
      mortality was 51.8% in the VA-ECMO group and 81.5% in the standard therapy arm 
      (HR 0.52, 95% CI: 0.21-1.26; p=0.14). Vascular and bleeding complications 
      occurred more often in the VA-ECMO arm (21.4% vs 0% and 35.7% vs 5.6%, 
      respectively). CONCLUSIONS: Due to the limited number of patients recruited to 
      the trial, no definite conclusions could be drawn from the available data. Our 
      study demonstrates the feasibility of randomising patients with CGS complicating 
      acute MI but also illustrates the challenges. We hope these data will inspire and 
      inform the design of future large-scale trials.
FAU - Banning, Amerjeet S
AU  - Banning AS
AD  - Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK.
AD  - Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
FAU - Sabate, Manel
AU  - Sabate M
AD  - Consorci Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), 
      Cardiovascular Institute, Hospital Clinic, Barcelona, Spain.
FAU - Orban, Martin
AU  - Orban M
AD  - Medizinische Klinik und Poliklinik I, LMU University Hospital Munich, Munich, 
      Germany.
FAU - Gracey, Jay
AU  - Gracey J
AD  - Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
FAU - Lopez-Sobrino, Teresa
AU  - Lopez-Sobrino T
AD  - Consorci Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), 
      Cardiovascular Institute, Hospital Clinic, Barcelona, Spain.
FAU - Massberg, Steffen
AU  - Massberg S
AD  - Department of Cardiology, Deutsches Herzzentrum Muenchen, German Center for 
      Cardiovascular Research (DZHK), Munich, Germany and Partner Site Munich Heart 
      Alliance, Munich, Germany.
FAU - Kastrati, Adnan
AU  - Kastrati A
AD  - Department of Cardiology, Deutsches Herzzentrum Muenchen, German Center for 
      Cardiovascular Research (DZHK), Munich, Germany and Partner Site Munich Heart 
      Alliance, Munich, Germany.
FAU - Bogaerts, Kris
AU  - Bogaerts K
AD  - Department of Public Health and Primary Care, KU Leuven, I-BioStat, Leuven, 
      Belgium and UHasselt, I-BioStat, Diepenbeek, Belgium.
FAU - Adriaenssens, Tom
AU  - Adriaenssens T
AD  - University Hospitals Leuven, Leuven, Belgium and Department of Cardiovascular 
      Sciences, KU Leuven, Leuven, Belgium.
FAU - Berry, Colin
AU  - Berry C
AD  - University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, 
      UK and Robertson Centre for Biostatistics, Glasgow, UK.
FAU - Erglis, Andrejs
AU  - Erglis A
AD  - Pauls Stradins Clinical University Hospital, Riga, Latvia and the University of 
      Latvia, Riga, Latvia.
FAU - Haine, Steven
AU  - Haine S
AD  - Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium and 
      Department of Cardiovascular Sciences, University of Antwerp, Antwerp, Belgium.
FAU - Myrmel, Truls
AU  - Myrmel T
AD  - Universitetssykehuset Nord-Norge, Tromso, Norway.
FAU - Patel, Sameer
AU  - Patel S
AD  - King's College Hospital and Faculty of Life Sciences & Medicine, King's College 
      London, London, UK.
FAU - Buera, Irene
AU  - Buera I
AD  - Hospital Universitario Vall d'Hebron, VHIR, Universidad Autonoma de Barcelona, 
      Barcelona, Spain.
FAU - Sionis, Alessandro
AU  - Sionis A
AD  - Cardiology Department, Intensive Cardiac Care Unit, Hospital de la Santa Creu i 
      Sant Pau, Barcelona, Spain and Universitat Autonoma de Barcelona, Barcelona, 
      Spain and Centro de Investigacion Biomedica en Red de Enfermedades 
      Cardiovasculares (CIBERCV), Madrid, Spain.
FAU - Vilalta, Victoria
AU  - Vilalta V
AD  - Interventional Cardiology Unit, Cardiology Department, Hospital Universitari 
      Germans Trias i Pujol, Badalona, Spain.
FAU - Yusuff, Hakeem
AU  - Yusuff H
AD  - Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK.
FAU - Vrints, Christiaan
AU  - Vrints C
AD  - Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium and 
      Department of Cardiovascular Sciences, University of Antwerp, Antwerp, Belgium.
FAU - Adlam, David
AU  - Adlam D
AD  - Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
FAU - Flather, Marcus
AU  - Flather M
AD  - University of East Anglia, Norwich, UK and Norfolk and Norwich University 
      Hospitals, Norwich, UK.
FAU - Gershlick, Anthony H
AU  - Gershlick AH
AD  - Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK.
AD  - Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PL  - France
TA  - EuroIntervention
JT  - EuroIntervention : journal of EuroPCR in collaboration with the Working Group on 
      Interventional Cardiology of the European Society of Cardiology
JID - 101251040
SB  - IM
MH  - Humans
MH  - Shock, Cardiogenic/etiology/therapy
MH  - *Extracorporeal Membrane Oxygenation/adverse effects
MH  - Pandemics
MH  - *COVID-19/etiology
MH  - *Myocardial Infarction/complications/therapy
MH  - Retrospective Studies
PMC - PMC10436068
COIS- M. Orban reports receiving payments or honoraria for lectures, presentations, 
      speakers' bureaus, manuscript writing or educational events from Abbott Medical, 
      AstraZeneca, Abiomed, Bayer Vital, Biotronik, Bristol-Myers Squibb, CytoSorbents, 
      Daiichi Sankyo Deutschland, Edwards Lifesciences, and Sedana Medical. T. 
      Lopez-Sobrino reports receiving payments or honoraria for presentations from the 
      University of Barcelona and the European Acute Cardiac Care Association. T. 
      Adriaenssens reports receiving honoraria from Abiomed for speakers' bureaus. C. 
      Berry is employed by the University of Glasgow, which holds research agreements 
      for his work with Abbott Vascular, AstraZeneca, Boehringer Ingelheim, and 
      HeartFlow; and holds consultancy and research agreements for his work with Abbott 
      Vascular, AstraZeneca, Auxilius Pharma, Boehringer Ingelheim, Causeway 
      Therapeutics, Coroventis, Genetech, GSK, HeartFlow, Menarini, Neovasc, Siemens 
      Healthcare, and Valo Health. D. Adlam has received funding to support a clinical 
      research fellow from Abbott Vascular; funding from AstraZeneca for unrelated 
      research; has conducted unrelated consultancy for GE HealthCare; holds patents 
      for medical devices, including a cardiac assist device (EP3277337A1, 
      PCT/GB2017/050877, UK PATENT APPLICATION NUMBER 2211616.4); and has received 
      royalties from Elsevier Inc. for ECG made Practical and ECG Problems books. M. 
      Flather reports receiving consulting fees from Boehringer Ingelheim for 
      consulting work unrelated to this project; speakers' fees from Menarini 
      International, AstraZeneca, and Bayer; support for attending meeting from 
      AstraZeneca, and modest honorarium as Deputy Editor of the European Heart Journal 
      ‒ Quality of Care & Clinical Outcomes. The other authors report no conflicts of 
      interest related to the reported study.
EDAT- 2023/06/19 06:42
MHDA- 2023/08/23 06:42
PMCR- 2024/08/21
CRDT- 2023/06/19 04:33
PHST- 2024/08/21 00:00 [pmc-release]
PHST- 2023/08/23 06:42 [medline]
PHST- 2023/06/19 06:42 [pubmed]
PHST- 2023/06/19 04:33 [entrez]
AID - EIJ-D-23-00204 [pii]
AID - 10.4244/EIJ-D-23-00204 [doi]
PST - ppublish
SO  - EuroIntervention. 2023 Aug 21;19(6):482-492. doi: 10.4244/EIJ-D-23-00204.