Higher Vasoactive Usage Despite Hemodynamic Goals is Associated with Higher Mortality in Acute Myocardial Infarction-Related Cardiogenic Shock

Jorge Arturo Ortega-Hernandez ^1* Héctor González-Pacheco ^1* Diego Araiza Garaygordobil ¹ Rodrigo Gopar-Nieto ¹ Daniel Sierra-Lara-Martínez ¹ Daniel Manzur-Sandoval ¹ José Luis Briseño-De-La-Cruz ¹ Salvador Mendoza-García ¹ Alvaro Montañez Orozco ¹ Arturo Arzate-Ramírez ¹ José Omar Arenas-Díaz ² César A Gómez-Rodríguez ¹ Hector Antonio Santos-Alfaro ¹ Jaime Hernández-Montfort ³ Alexandra Arias -Mendoza ¹

• ¹ Unidad de Cuidados Coronarios, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
• ² Interventional Cardiology Unit, National Institute of Cardiology Ignacio Chavez, Mexico, Mexico
• ³ Baylor Scott and White Health, Temple, New Hampshire, United States

Background: Cardiogenic shock (CS) is a severe complication of acute myocardial infarction (AMI) with high mortality. Few studies have examined the selection and subsequent choice of vasoactive agents in CS.This study investigates the impact of vasoactive drug use and in-hospital outcomes among AMI-CS.: 309 patients who underwent pulmonary artery catheterization between 2006-2021 were categorized by the number of vasoactive drugs used (0-1, 2, or > 2). Clinical and 24-hour hemodynamic data were analyzed. Primary outcomes explored the correlation between vasoactive use and in-hospital mortality. Secondary analyses assessed hemodynamic changes and estimated mortality probabilities at different intervals through logistic regression.Results: In total, 57 patients received 0-1, 76 received 2, and 176 received >2 vasoactives. The median age was 61; most were men (82%), and 82.8% had STEMI. End-organ function showed progressive deterioration with escalating vasoactive use. Survival analysis revealed an increased mortality in >2 vasoactive group (HRa=4.62 [2.07-10.32]), achieving ≥5/6 hemodynamic goals did not mitigate mortality ). Subgroup analyses within patients who reached different hemodynamic goals reiterated adverse outcomes associated with >2 vasoactives(P<0.05). Further analysis showed that vasopressin was associated with the highest mortality with a time-dependent fashion (HRDay1,, also levosimendan had similar behavior (HRDay1,] → HRDay30, 0.66 [0.42-1.03]).Conclusions: A significant association between the number of vasoactives and in-hospital mortality was found in AMI-CS, which requires future long-term studies to explore the role of vasoactive drug therapies and early temporary mechanical circulatory support.