Clinical Prediction Score for Successful Liberation from Temporary Mechanical Circulatory Support in Cardiogenic Shock Patients

Abstract

Background

In cardiogenic shock (CS) patients requiring temporary mechanical circulatory support (tMCS), assessing cardiac recovery vs the need for heart replacement therapy is critical. We developed and validated a new clinical score aimed at predicting successful tMCS liberation.

Methods

A cohort of 80 CS patients treated with Impella support between January 2018 and December 2020 was analyzed. Hemodynamic, echocardiographic, and laboratory data were collected at baseline, 24 hours, 48 hours, and 96 hours after device insertion. Patients were classified as successfully or unsuccessfully liberated from tMCS, based on recovery vs progression to death, left ventricular assist device implantation, or heart transplant. The W score, derived using independent predictors of successful liberation, was validated in 2 cohorts: 86 CS patients at our center and 23 patients from an external center.

Results

Among the 80 patients (mean age 62.5 ± 11.8 years, 63.7% acute myocardial infarction CS), 47.5% achieved successful tMCS liberation. Independent predictors included left ventricular ejection fraction, N-terminal pro–brain natriuretic peptide, and inotropic score at 24 hours, along with creatinine and lactate at 96 hours (area under the curve [AUC] ≥ 0.7, P < 0.05). The W score, using a cutoff of ≥7, demonstrated good diagnostic accuracy (AUC 0.92, sensitivity 80%, specificity 85%, P < 0.001). In validation cohorts, a score ≥7 predicted successful liberation with AUCs of 0.80 (P < 0.001) and 0.72 (P < 0.015) at the internal and external centers, respectively.

Conclusions

The W score, based on key parameters at 24 and 96 hours post-tMCS, effectively supports clinicians in identifying CS patients likely to achieve successful tMCS liberation.