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 versus 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, 24h, 48h, and 96h after device insertion. Patients were classified as successfully or unsuccessfully liberated from tMCS, based on recovery versus progression to death, LVAD implantation, or heart transplant. The W-score, derived using independent predictors of successful liberation, was validated in two 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% AMI-CS), 47.5% achieved successful tMCS liberation. Independent predictors included LVEF, NT-proBNP, and inotropic score at 24h, along with creatinine and lactate at 96h (AUC ≥ 0.7, p < 0.05). The W-score, using a cut-off 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.