# DanGer Shock: Impella versus standaardzorg bij cardiogene shock — NEJM

*geplaatst 2024-04-18 · Algemeen · The New England journal of medicine · doi 10.1056/NEJMoa2312572 · https://hartvaat.nl/2024/04/18/danger-shock-impella-versus-standaardzorg-bij-cardiogene-shock-nejm/*

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.

## English: Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock.

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.

## Abstract (original, from the publication)

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.).

Auteurs: 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

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Bron: The New England journal of medicine, https://doi.org/10.1056/NEJMoa2312572. Bijgewerkt 2026-07-03T13:29:55Z. 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.