Acute cardiac care & resuscitation
Escalation of mechanical circulatory support in patients with STEMI-related cardiogenic shock: a post hoc analysis of the Danish German (DanGer) Shock trial
Primary result · tMCS escalationResult — go to the resultAdjusted odds ratio 0.52 95% CI 0.30–0.91Authors' conclusion
In the DanGer Shock trial of STEMI-related cardiogenic shock, escalation to tMCS occurred in almost 1/5 patients, was more likely in the control group, and was associated with a higher mortality risk. Even with early escalation (<1 h), patients escalated from the control group had the highest mortality, underscoring the need for future trials to define optimal escalation strategies.
Study context
- Population
- Non-comatose patients with STEMI-related cardiogenic shockpatients included in the DanGer Shock trial, 60 underwent tMCS escalation
- Participants
- 355 patients
- Comparison
- Escalated vs. not escalated to treatments other than a percutaneously implanted micro-axial flow pump (mAFP), in patients randomized to mAFP vs. standard of care
- mAFPn = 179
- Standard of caren = 176reference
Primary result
tMCS escalation
Adjusted odds ratio
0.52
95% CI 0.30–0.91
Events by treatment group
mAFPvs standard of care
adjusted odds ratio 0.52 (95% CI 0.30–0.91)
As reported in the abstract
Further findings
Time from randomization to escalation
P < 0.001
| Outcome | P value |
|---|---|
| 180-day all-cause mortality, escalated vs. not escalatedHigher with escalation | P < 0.01 |
- 180-day all-cause mortality, escalated vs. not escalated — escalated patients from the standard of care arm (highest)
- 80.0%
- 180-day all-cause mortality, escalated vs. not escalated — escalated in the mAFP arm
- 60.0%
- 180-day all-cause mortality, escalated vs. not escalated — non-escalated patients in the standard of care group
- 53.2%
- 180-day all-cause mortality, escalated vs. not escalated: escalated 71.7%
- 180-day all-cause mortality, escalated vs. not escalated: not escalated 48.1%
Higher baseline lactate as predictor of escalation
- Standard of care arm, odds ratio 1.80 (95% confidence interval 1.14-3.13)
- 1.80
- mAFP arm, odds ratio 0.57 (95% confidence interval 0.29-1.15)
- 0.57
- interaction-P < 0.01
Original publication
Escalation of mechanical circulatory support in patients with STEMI-related cardiogenic shock: a post hoc analysis of the DanGer Shock trial. Eur Heart J Acute Cardiovasc Care. Published 29 January 2026. doi:10.
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