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Acute cardiac care & resuscitationSecondary analysis

Escalation of mechanical circulatory support in patients with STEMI-related cardiogenic shock: a post hoc analysis of the Danish German (DanGer) Shock trial

Eur Heart J Acute Cardiovasc CarePublished

  • post hoc analysis of the DanGer Shock trial
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Authors' 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
Micro-axial flow pump (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

mAFP vs 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

OutcomeP value
180-day all-cause mortality, escalated vs. not escalated · higher with escalationP < 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:10.1093/ehjacc/zuag015
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Summarised from the published abstract; every number is checked against it