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Letters to the Editor regarding the article The Prognosis of Cardiogenic Shock Following Acute Myocardial Infarction An Analysis of 2693 Cases From a Prospective Multicenter Registry by Tamilla Muzafarova, Zuzana Motovska, Ota Hlinomaz, Petr Kala, Milan Hromadka, Jan Precek, Jan Mrozek, Jan Matejka, Jiri Kettner, Josef Bis, and Jiri Jarkovsky in issue 31–32/2023

We read with interest the article by Muzafarova et al. on the prognostic importance of shock severity and the timing of revascularization in infarction-related cardiogenic shock (1). We suggest the following additions. With worsening levels of systemic hypoperfusion, the availability of mechanical circulation support (MCS) gains prognostic importance. This is particularly important in hybrid systems, which generate a normal cardiac output and can also unload the left ventricle and the pulmonary circulation, such as ECMELLA. In this setting, MCS can not only mitigate the deleterious sequelae of hypoperfusion and end organ ischemia but may also potentially reduce permanent loss of myocardial pump function by decreasing cardiac preload and afterload (2, 3). Even a slight delay in revascularization to initiate MCS immediately prior to revascularization in the cardiac catheter lab did not appear to have any negative effects in initial studies if it resulted in rapid unloading of the injured left ventricle (4). Are there any relevant data in the registry in this regard?

DOI: 10.3238/arztebl.m2024.0056

Dr. med. Felix Hennig, Prof. Dr. med. Evgenij V. Potapov, Prof. Dr. med. Volkmar Falk, Prof. Dr. med. Christoph Knosalla

Deutsches Herzzentrum der Charite;
Klinik für Herz-, Thorax- und Gefäßchirurgie;

Conflict of interest statement

EVP has received honoraria and institutional funding from Abiomed and Getinge. He has received consulting fees from Abiomed, had travel costs paid by Abiomed, and received honoraria for lectures from Abiomed and Getinge.

VF has received study support from Abiomed and Abbott. He is a member of the advisory board of Berlin Heart.

CK and FH declare that no conflict of interest exists.

References

1. Muzafarova T, Motovska Z, Hlinomaz O, et al.: The prognosis of cardiogenic shock following acute myocardial infarction—an analysis of 2693 cases from a prospective multicenter registry. Dtsch Arztebl Int 2023; 120: 538–9

2. Basir MB, Schreiber T, Dixon S, et al.: Feasibility of early mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock: the Detroit Cardiogenic Shock Initiative. Catheter Cardiovasc Interv 2018; 91: 454–61

3. Bartos JA, Carlson K, Carlson C, et al.: Surviving refractory out-of-hospital ventricular fibrillation cardiac arrest: critical care and extracorporeal membrane oxygenation management. Resuscitation 2018; 132: 47–55.

4. Kapur NK, Alkhouli MA, DeMartini TJ, et al.: Unloading the left ventricle before reperfusion in patients with anterior ST-segment-elevation myocardial Infarction. Circulation. 2019; 139: 337–46