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Elizabeth Horn
Eight to ten percent of individuals who have a heart attack will also experience acute myocardial infarction cardiogenic shock. This happens when there is an abrupt, complete blockage of one of the arteries to the heart making it unable to pump enough blood to carry nutrients and oxygen to the rest of the body. Patients experiencing acute myocardial infarction cardiogenic shock are extremely sick, and 40 – 50% die.
Incoming Director of BMC2 PCI, Eric Cantey, MD and his colleagues looked at data from patients in Michigan who experienced acute myocardial infarction cardiogenic shock between April 2018 and March 2024. They learned that while each hospital in Michigan treated a patient with this kind of cardiogenic shock during that time, each interventional cardiologist saw only 0.33 – 1.67 cases per year.
The findings were published in “Managing Cardiogenic Shock Caused by Acute Myocardial Infarction: Invisible Challenges Revealed in a Statewide Registry,” in the Journal of the American College of Cardiology (JACC).
“These patients are arguably the sickest patients to enter the cath lab,” said Dr. Cantey. “It is unrealistic for every team member that sees the patient to feel comfortable with the unique management of these patients if they are only personally caring for several patients per year.”
Teams include physicians, nurses, and radiation technologists in the emergency room, catheterization lab and intensive care unit.
The treatment of acute myocardial infarction cardiogenic shock involves multiple phases of care:
- Early recognition of cardiogenic shock
- Prompt treatment of the occluded blood vessel
- Determining the severity of cardiogenic shock early
- Safe and effective mechanical circulatory support
- Vigilant intensive care unit care
A large portion of Consortium participants believe that developing a BMC2 Shock Initiative is important to patients. BMC2 is in the very early stages of developing the BMC2 Shock initiative with a multi-faceted approach of education, shock protocol implementation, and best practices for Year 1.
BMC2 has many engaged members and sites that collaborate to create meaningful quality improvement in PCI. The Consortium’s dataset covers a diverse population throughout Michigan–from the rural upper peninsula to urban Detroit. “This diversity allows us to drive quality improvement and also provide real-world change,” Dr. Cantey said.
However, variations in procedures for patients experiencing cardiogenic shock bring risks. Differences in the technique a mechanical support device was placed with, the timing of placement, and the post-procedure management can lead to poor outcomes. With the formation of protocols and best practices, the Consortium hopes to decrease variability and ensure best practices, leading to better outcomes and improvements in quality of care.
Most patients in the state will begin care at a hospital with lower volumes of acute myocardial infarction cardiogenic shock. These “spokes” will be tasked with these patients' initial stabilization, revascularization, and support.
When these hospitals do not have the resources to support the patient outside of the cath lab, another spoke or hub–like tertiary care centers, or centers with expertise in the management of mechanical circulatory support, critical care cardiology, and advanced heart failure options (durable Left Ventricular Assist Device mechanical pumps and transplant)–can accept these patients to offer them the full spectrum of acute myocardial infarction cardiogenic shock care.
The Consortium will not define which sites are hubs and which are spokes. Local referral patterns, ICU bed availability, and individual site expertise will likely drive site identification.
“By establishing best practices in each phase of care and partnering with our intensive care unit colleagues,” Dr. Cantey said, “the collaborative spirit of BMC2 will again contribute to Michigan being one of the safest places in the nation to receive cardiovascular care.”
Publication co-authors are Aaron Lopacinski, MD; Milan Seth, MS; David E. Hamilton, MD; Elias J. Dayoub, MD; Siddharth Gandhi, DO; Mir B. Basir, DO; Amir Kaki, MD; Ryan D. Madder, MD; Devraj Sukul, MD; and Hitinder S. Gurm, MD.
Learn more at PubMed.