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Randomized Controlled Trial
. 2025 Feb 20;14(2):59-70.
doi: 10.1093/ehjacc/zuae148.

C-reactive protein levels and outcomes in infarct-related cardiogenic shock: data from the ECLS-SHOCK trial

Tobias Schupp  1 , Holger Thiele  2 , Tienush Rassaf  3 , Amir Abbas Mahabadi  3 , Ralf Lehmann  4 , Ingo Eitel  5 , Carsten Skurk  6 , Peter Clemmensen  7 , Marcus Hennersdorf  8 , Ingo Voigt  9 , Axel Linke  10 , Eike Tigges  11 , Peter Nordbeck  12 , Christian Jung  13 , Philipp Lauten  14 , Hans-Josef Feistritzer  2 , Maria Buske  2 , Janine Pöss  2 , Taoufik Ouarrak  15 , Steffen Schneider  15 , Michael Behnes  1 , Daniel Duerschmied  1 , Steffen Desch  2 , Anne Freund  2 , Uwe Zeymer  15 , Ibrahim Akin  1
Affiliations
Randomized Controlled Trial

C-reactive protein levels and outcomes in infarct-related cardiogenic shock: data from the ECLS-SHOCK trial

Tobias Schupp et al. Eur Heart J Acute Cardiovasc Care. .

Abstract

Aims: The impact of systemic inflammation in acute myocardial infarction complicated by cardiogenic shock (AMI-CS) is still a matter of debate. The present ECLS-SHOCK sub-study investigates the association of C-reactive protein (CRP) levels with short-term outcomes in patients with AMI-CS.

Methods and results: Patients with AMI-CS enrolled in the multicentre, randomized ECLS-SHOCK trial between 2019 and 2022 were included. The prognostic impact of CRP levels on admission, as well as the effect of extracorporeal life support (ECLS), stratified by CRP levels, was tested with regard to the primary endpoint of 30-day all-cause mortality. In 371 patients with AMI-CS and available CRP level on baseline, the median CRP level was 18.0 mg/L. Patients with CRP levels in the highest tertile were older and less often resuscitated from cardiac arrest. The highest tertile (i.e. CRP >61.0 mg/L) was associated with an increased risk of 30-day all-cause mortality compared with patients with lower CRP levels (lowest tertile: ≤5.0 mg/L) [adjusted odds ratio: 3.54; 95% confidence interval (CI) 1.88-6.68; P = 0.001]. The use of ECLS did not reduce 30-day all-cause mortality, irrespective of CRP levels on admission. The additional inclusion of CRP to the IABP-SHOCK II score was associated with a slight improvement of the prediction of 30-days all-cause mortality (area under the curve: 0.74; 95% CI 0.68-0.79).

Conclusion: Higher CRP levels were independently associated with the risk of 30-day all-cause mortality in AMI-CS. The additional inclusion of CRP to a validated CS risk score may further improve the prediction of short-term prognosis.

Keywords: Acute myocardial infarction; C-reactive protein; Cardiogenic shock; ECLS; Inflammation; Mortality.

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Conflict of interest statement

Conflict of interest: T.R. has received honoraria, lecture fees, and grant support from Edwards Lifesciences, AstraZeneca, Bayer, Novartis, Berlin Chemie, Daiicho-Sankyo, Boehringer Ingelheim, Novo Nordisk, Cardiac Dimensions, and Pfizer, all unrelated to this work. He is a co-founder of Bimyo GmbH, a company that develops cardioprotective peptides. P.C. has previously or currently been involved in research contracts, consulting, speakers bureau, or received research and/or educational grants from: Abbott, Abiomed, AstraZeneca, Aventis, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, CeleCor, CytoSorbent, Daiichi Sankyo, Eli-Lilly, Evolva, Ferrer, Fibrex, Idorsia, Janssen, Merck, Myogen, Medtronic, Mitsubishi Pharma, the Medicines Company, Nycomed, Organon, Pfizer, Pharmacia, Philips, Regado, Sanofi, Searle, Servier, and ViFor Pharma. A.L. has received grants from Novartis and Edwards Lifesciences; personal fees from Abbott, Abiomed, AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Edwards Lifesciences, Medtronic, Meril, Novartis, Sanofi Genzyme, and Pfizer; and other fees from Picardia, Filterlex, and Transverse Medical outside the submitted work. J.P.: Research foundation (institutional): German Cardiac Society, German Heart Research Foundation, Dr Rolf M. Schwiete Foundation, Maquet Cardiopulmonary GmbH. The other authors declare that they do not have any conflict of interest.

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