Differential Prognostic Implications of Vasoactive Inotropic Score for Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock According to Use of Mechanical Circulatory Support*

Abstract

OBJECTIVES: To identify whether the prognostic implications of Vasoactive Inotropic Score according to use of mechanical circulatory support differ in the treatment of acute myocardial infarction complicated by cardiogenic shock. DESIGN: A multicenter retrospective and prospective observational cohort study. SETTING/PATIENT: The REtrospective and prospective observational Study to investigate Clinical oUtcomes and Efficacy registry includes 1,247 patients with cardiogenic shock from 12 centers in Korea. A total of 836 patients with acute myocardial infarction complicated by cardiogenic shock were finally selected, and the study population was stratified by quartiles of Vasoactive Inotropic Score (< 10, 10–30, 30–90, and > 90) for the present study. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Primary endpoint was in-hospital mortality and secondary endpoint was follow-up mortality. Among the study population, 326 patients (39.0%) received medical treatment alone, 218 (26.1%) received intra-aortic balloon pump, and 292 (34.9%) received extracorporeal membrane oxygenation. In-hospital mortality occurred in 305 patients (36.5%) and was significantly higher in patients with higher Vasoactive Inotropic Score (15.6%, 20.8%, 40.2%, and 67.3%, for < 10, 10–30, 30–90, and > 90; p < 0.001). Vasoactive Inotropic Score showed better ability to predict in-hospital mortality in acute myocardial infarction patients with cardiogenic shock who received medical treatment alone (area under the curve: 0.797; 95% CI, 0.728–0.865) than in those who received intra-aortic balloon pump (area under the curve, 0.704; 95% CI, 0.625–0.783) or extracorporeal membrane oxygenation (area under the curve, 0.644; 95% CI, 0.580–0.709). The best cutoff value of Vasoactive Inotropic Score for the prediction of in-hospital mortality also differed according to the use of mechanical circulatory support (16.5, 40.1, and 84.0 for medical treatment alone, intra-aortic balloon pump, and extracorporeal membrane oxygenation, respectively). There was a significant interaction between Vasoactive Inotropic Score as a continuous value and the use of mechanical circulatory support including intra-aortic balloon pump (interaction-p = 0.006) and extracorporeal membrane oxygenation (interaction-p < 0.001) for all-cause mortality during follow-up. CONCLUSIONS: High Vasoactive Inotropic Score was associated with significantly higher in-hospital and follow-up mortality in patients with acute myocardial infarction complicated by cardiogenic shock. The predictive value of Vasoactive Inotropic Score for mortality was significantly higher in acute myocardial infarction patients with cardiogenic shock treated by medical treatment alone than in those treated by mechanical circulatory support such as intra-aortic balloon pump or extracorporeal membrane oxygenation.

Predictive Value of Blood Urea Nitrogen to Albumin Ratio in Long-Term Mortality in Intensive Care Unit Patients with Acute Myocardial Infarction: A Propensity Score Matching Analysis

“…It had been suggested that Vasoactive Inotropic Score (VIS), an objective measure of the magnitude of vasoactive agent support, was a predictor of clinical outcomes in cardiac surgery. 28 In addition, VIS was significantly associated with increased in-hospital mortality in adult patients with cardiogenic shock. 28 The results of our study were consistent with the previous evidence.…”

“… 28 In addition, VIS was significantly associated with increased in-hospital mortality in adult patients with cardiogenic shock. 28 The results of our study were consistent with the previous evidence.…”

Vasoactive-Inotropic Score as a Determinant of Timely Initiation of Venoarterial Extracorporeal Membrane Oxygenation in Patients With Cardiogenic Shock

“…However, Choi et al reported that the VIS could predict in-hospital outcomes among patients with acute cardiogenic shock due to myocardial infarction. 20 Therefore, despite its property that changes over time, a VIS may have a predictive role and be useful for deciding the initiation of VA-ECMO. Fifth, the study population only included those with cardiogenic shock who had already received VA-ECMO.…”

Hemodynamic effects of COVID-19 vaccination in hospitalized patients awaiting heart transplantation

“…Primary outcomes included changes in inotrope or vasopressor infusion rates. The maximal vasoactive inotrope score (VIS) was calculated manually using the formula suggested by Gaies et al [7] and validated in adult populations [8] , [9] (VIS = dopamine dose (μg/kg/min) + dobutamine dose (μg/kg/min) + 100 × epinephrine dose (μg/kg/min) + 10 × milrinone dose (μg/kg/min) + 10,000 × vasopressin dose (U/kg/min) + 100 × norepinephrine dose (μg/kg/min)). Secondary outcomes included vital signs, hemodynamic measurements from pulmonary artery catheters, total daily dosage of loop diuretics, thiazide diuretic use, urine output, arrhythmias, and serologic measures of renal function and blood cell counts.…”