{"id":"4caeceb85bde","type":"article","url":"https://hartvaat.nl/2024/04/18/danger-shock-impella-versus-standaardzorg-bij-cardiogene-shock-nejm/","title":"DanGer Shock: Impella versus standaardzorg bij cardiogene shock — NEJM","title_en":"Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["cardiogene-shock"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2312572","source_url":"https://doi.org/10.1056/NEJMoa2312572","authors":["Jacob E Møller","Thomas Engstrøm","Lisette O Jensen","Hans Eiskjær","Norman Mangner","Amin Polzin","P Christian Schulze","Carsten Skurk","Peter Nordbeck","Peter Clemmensen","Vasileios Panoulas","Sebastian Zimmer","Andreas Schäfer","Nikos Werner","Martin Frydland","Lene Holmvang","Jesper Kjærgaard","Rikke Sørensen","Jacob Lønborg","Matias G Lindholm","Nanna L J Udesen","Anders Junker","Henrik Schmidt","Christian J Terkelsen","Steffen Christensen","Evald H Christiansen","Axel Linke","Felix J Woitek","Ralf Westenfeld","Sven Möbius-Winkler","Kristian Wachtell","Hanne B Ravn","Jens F Lassen","Søren Boesgaard","Oke Gerke","Christian Hassager"],"significance":10,"published":"2024-04-18","source_date":"2024-04-18","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/kleplijden/klepprothese-mechanisch-biologisch/"],"congress":"","summary_en":"The DanGer Shock trial demonstrated that the Impella CP microaxial flow pump significantly reduced 180-day all-cause mortality compared with standard care in patients with STEMI-related cardiogenic shock. This is the first positive randomized trial of a percutaneous mechanical circulatory support device in cardiogenic shock.","created":"2026-07-03T10:30:52Z","updated":"2026-07-03T13:29:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De DanGer Shock-trial in de NEJM toonde dat microaxiale hartpomp (Impella CP) de 180-dagenmortaliteit significant verminderde bij infarctgerelateerde cardiogene shock zonder ECMO. Dit is de eerste positieve RCT voor mechanische circulatoire ondersteuning bij cardiogene shock.","abstract_original":"BACKGROUND: The effects of temporary mechanical circulatory support with a microaxial flow pump on mortality among patients with ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock remains unclear. METHODS: In an international, multicenter, randomized trial, we assigned patients with STEMI and cardiogenic shock to receive a microaxial flow pump (Impella CP) plus standard care or standard care alone. The primary end point was death from any cause at 180 days. A composite safety end point was severe bleeding, limb ischemia, hemolysis, device failure, or worsening aortic regurgitation. RESULTS: A total of 360 patients underwent randomization, of whom 355 were included in the final analysis (179 in the microaxial-flow-pump group and 176 in the standard-care group). The median age of the patients was 67 years, and 79.2% were men. Death from any cause occurred in 82 of 179 patients (45.8%) in the microaxial-flow-pump group and in 103 of 176 patients (58.5%) in the standard-care group (hazard ratio, 0.74; 95% confidence interval [CI], 0.55 to 0.99; P = 0.04). A composite safety end-point event occurred in 43 patients (24.0%) in the microaxial-flow-pump group and in 11 (6.2%) in the standard-care group (relative risk, 4.74; 95% CI, 2.36 to 9.55). Renal-replacement therapy was administered to 75 patients (41.9%) in the microaxial-flow-pump group and to 47 patients (26.7%) in the standard-care group (relative risk, 1.98; 95% CI, 1.27 to 3.09). CONCLUSIONS: The routine use of a microaxial flow pump with standard care in the treatment of patients with STEMI-related cardiogenic shock led to a lower risk of death from any cause at 180 days than standard care alone. The incidence of a composite of adverse events was higher with the use of the microaxial flow pump. (Funded by the Danish Heart Foundation and Abiomed; DanGer Shock ClinicalTrials.gov number, NCT01633502.)."}