Right ventricular congestion in AMICS was associated with the highest all-cause mortality (42.9%) compared to euvolemic (6.3%), left (8.3%), and biventricular (13.5%) congestion (p=0.017).
Cohort (n=93)
No
Does right heart catheterisation-derived congestion phenotyping predict clinical outcomes in patients with acute myocardial infarction with cardiogenic shock?
In patients with acute myocardial infarction and cardiogenic shock, right ventricular congestion identified by right heart catheterisation is associated with the highest mortality, highlighting the value of haemodynamic phenotyping for risk stratification.
valor p: p=0.707
Abstract Background Acute myocardial infarction with cardiogenic shock (AMICS) is a life-threatening condition with high morbidity and mortality. Right heart catheterisation (RHC)-guided haemodynamic assessment enables classification of ventricular congestion patterns, which may have prognostic value. Purpose This study aimed to evaluate the clinical impact of different congestion phenotypes in AMICS based on RHC-derived right atrial pressure (RAP) and pulmonary capillary wedge pressure (PCWP). Methods Ninety-three patients with AMICS who underwent RHC at our center between 2018 and 2024 were classified as euvolemic (EuV), left ventricular congestion (LV), right ventricular congestion (RV), or biventricular congestion (BiV) based on RAP and PCWP. Baseline characteristics, hemodynamics, and clinical outcomes were compared among the groups. Results The cohort had a mean age of 54 ± 10 years, and 94.6% were male. Haemodynamic parameters varied significantly, with the BiV group exhibiting the highest RAP and PCWP. The primary composite outcome (all-cause mortality, acute kidney injury, acute liver injury, mechanical ventilation, or arrhythmia) occurred in 62.2%–78.6% of patients across congestion groups (p=0.707). All-cause mortality was highest in the RV group (42.9%) compared to EuV (6.3%), LV (8.3%), and BiV (13.5%) (p=0.017). Other outcomes, including acute kidney injury, acute liver injury, mechanical ventilation, and arrhythmia, were not significantly different among groups. Conclusion Among patients with AMICS, right ventricular congestion was associated with the highest mortality. Haemodynamic phenotyping via RHC may aid risk stratification and guide tailored management strategies.
Habib et al. (Sat,) conducted a cohort in Acute myocardial infarction with cardiogenic shock (AMICS) (n=93). Right heart catheterisation-derived congestion phenotyping vs. Comparison among congestion phenotypes (EuV, LV, RV, BiV) was evaluated on Composite of all-cause mortality, acute kidney injury, acute liver injury, mechanical ventilation, or arrhythmia (p=0.707). Right ventricular congestion in AMICS was associated with the highest all-cause mortality (42.9%) compared to euvolemic (6.3%), left (8.3%), and biventricular (13.5%) congestion (p=0.017).