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Rationale and design of DanGer shock: Danish-German cardiogenic shock trial

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  1. Atrial fibrillation is a marker of increased mortality risk in non-ischemic heart failure - results from the DANISH Trial

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  1. Prognosis of myocardial infarction-related cardiogenic shock according to preadmission out-of-hospital cardiac arrest

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  2. Selective intracoronary hypothermia in patients with ST-elevation myocardial infarction. Rationale and design of the EURO-ICE Trial

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  3. Incidence, Predictors and Outcome of In-Hospital Bleeding in Patients With Cardiogenic Shock Complicating Acute Myocardial Infarction

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  4. Five-year clinical outcomes of zotarolimus-eluting stents in coronary total occlusions

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  5. Five-year risk of heart failure and death following myocardial infarction with cardiogenic shock: a nationwide cohort study

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OBJECTIVE: The DanGer Shock trial test the hypothesis that left ventricular (LV) mechanical circulatory support with Impella CP transvalvular microaxial flow pump improves survival in patients with ST segment elevation acute myocardial infarction complicated by cardiogenic shock (AMICS) compared to conventional guideline-driven treatment. This paper describes the rationale and design of the randomized trial, in addition to the baseline characteristics of the population screened and enrolled so far.

METHODS: The DanGer Shock study is a prospective, multicenter, open-label trial in patients with AMICS randomized 1:1 to Impella CP or current guideline-driven therapy with planned enrollment of 360 patients. Patients comatose after out of hospital cardiac arrest are excluded. Eligible patients are randomized immediately following shock diagnosis. Among patients randomized to receive Impella CP, the device is placed prior to angioplasty. The primary endpoint is all-cause mortality at 180 days. Baseline characteristics of patients screened and randomized in the DanGer Shock as of June 2018 are compared with 2 contemporary AMICS studies.

RESULTS: As of end of June 2018, 314 patients were screened and 100 patients were randomized. Patients had median arterial lactate of 5.5 mmol/L (interquartile range 3.7-8.8 mmol/L), median systolic blood pressure of 76 mmHg (interquartile range 70-88 mmHg), and median LV ejection fraction of 20% (interquartile range 10%-30%).

CONCLUSION: The DanGer Shock trial will be the first adequately powered randomized trial to address whether mechanical circulatory LV support with Impella CP can improve survival in AMICS. Baseline characteristics of the first 100 randomized patients indicate a population in profound cardiogenic shock.

Original languageEnglish
JournalAmerican Heart Journal
Volume214
Pages (from-to)60-68
Number of pages9
ISSN0002-8703
DOIs
Publication statusPublished - 1 Aug 2019

ID: 58041916