Multi-center Collaborative to Enhance Quality and Outcomes in the Management of Cardiogenic Shock (VANQUISH SHOCK)

This large real-world international prospective registry will provide a unique opportunity to comprehensively understand the contemporary management, clinical course and short as well as long-term outcomes of all Cardiogenic Shock (CS) patients cared for at four high volume dedicated shock care centers. As the first true North American multicenter CS collaborative with a uniform dedicated and comprehensive case report form, the high patient volumes and wide spectrum of clinical acuity seen at these institutions will provide valuable insight into the factors associated with adverse outcomes; and will serve as a blueprint for future clinical trial designs that may better inform clinical practice.

Study Overview

• Status: Recruiting
• Conditions: Acute Myocardial Infarction; Cardiogenic Shock

Detailed Description

Cardiogenic shock (CS) is a hemodynamically complex and morbid syndrome characterized by frank circulatory collapse and end organ malperfusion stemming from severely impaired myocardial contractility. Despite advances in early reperfusion and regionalized systems of care, it remains the leading cause of in-hospital death following acute myocardial infarction (AMI) to this day, with mortality rates in excess of 40%. CS is also multifactorial with etiologies that extend beyond the reaches of acute coronary thrombosis, as more than 60% of cases may be due to acute decompensated heart failure (ADHF), a heterogenous conglomeration of disease states that remain poorly understood with equally dismal outcomes. In addition, while there has been a growing interest and significant uptake in the utilization of percutaneous mechanical circulatory support devices (pMCS) capable of providing greater procedural hemodynamics compared to the traditional intra-aortic balloon pump (IABP), they have yet to demonstrate a survival benefit.

In the absence of randomized trials to inform clinical care, there has been a growing interest in the development of an algorithmic approach to guide CS management, predicated on: 1) Early disease recognition; 2) Classification using a standardized nomenclature that incorporates comprehensive hemodynamics; 3) Selective and phenotypically tailored selective circulatory support; and 4) Multidisciplinary team-based care. While preliminary short-term results from United States CS registries employing such an approach has been favorable, there remain gaps in knowledge regarding a number of clinical domains in CS care, including: 1) Prognostic validation of invasive hemodynamics and risk stratification tools at the time of diagnosis; 2) Best practices for revascularization using contemporary therapies for AMI-CS patients; 3) Clinical predictors of outcomes among the different severity stages of CS; 4) Potential merits of varying care models (hub-and-spoke networks, high intensity cardiac intensive care units; 5) Ideal weaning strategies for peripheral mechanical circulatory support (pMCS) devices; and 6) Intermediate and long-term outcomes following the index clinical event, including health-related quality of life measures in this highly frail and vulnerable patient population.

This registry will prospectively and retrospectively follow all patients admitted to their respective health care systems with the primary diagnosis of CS. Unlike other registries, patients will be followed even if mechanical circulatory support is not implemented. Each patient will be followed from time of hospital admission to disposition, and at 30 days, 6 months and 1 year following discharge. A comprehensive and detailed evaluation of each patient and de-identified variables will be collected during these time periods, including baseline demographics, index and serial hemodynamic/metabolic assessments, and clinical care during the longitudinal hospital course. Data will be collected regarding revascularization strategies, vasopressor dosing and pMCS device utilization, to include weaning and escalation strategies. Information will also be collected regarding any morbidities sustained during the course of care, both in the cardiac intensive care unit (CICU) and during the post-ICU course. These include major bleeding, vascular complications requiring surgical or endovascular therapy, device-related hemolysis, need for renal replacement therapy and stroke. Among patients surviving the index hospitalization, they will also undergo cognitive and health-related quality of life evaluations using validated instruments at 30 days, 6 months and 1 year.

• Study Type: Observational
• Enrollment (Estimated): 500

Contacts and Locations

• Study Contact: Name: John Kirk; Phone Number: 801-585-2944; Email: john.kirk@hsc.utah.edu

Study Locations

• Canada
  • Ontario
    • Toronto, Ontario, Canada
      • Recruiting
      • University of Toronto
      • Principal Investigator: Adriana Luk, M.D.
      • Contact: Adriana Luk, M.D.; Phone Number: 416-340-4800; Email: Adriana.luk@uhn.ca
• United States
  • Florida
    • Weston, Florida, United States, 33331
      • Recruiting
      • Cleveland Clinic Florida
      • Principal Investigator: David Baran, M.D.
      • Contact: Diana Yanez, BSN, RN; Phone Number: 954-659-5570; Email: YANEZD@ccf.org
  • Virginia
    • Falls Church, Virginia, United States, 22042
      • Recruiting
      • Inova Heart and Vascular Institute
      • Principal Investigator: Wayne Batchelor, MD
      • Contact: Juan Carlos Ojeda; Phone Number: 703-776-3779; Email: Juancarlos.Encisoojeda@inova.org

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Patients presenting with cardiogenic shock at one of four high-volume North American quaternary care centers (Inova Heart and Vascular Institute, Sentara Norfolk General Hospital, University of Toronto and University of Utah)

Description

Inclusion Criteria:

• Primary diagnosis of cardiogenic shock at time of index evaluation; including acute myocardial infarction- and acute decompensated heart failure-cardiogenic shock phenotypes
• Patients with cardiac arrest complicating cardiogenic shock and those with massive pulmonary embolism with right ventricular cardiogenic shock will also be eligible for the registry

Exclusion Criteria:

• Patients with shock not due to primary cardiac etiology will be excluded. These include septic, hemorrhagic, and anaphylactic shock.

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Prospective

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort
Cardiogenic shock cohort; Primary diagnosis of Cardiogenic Shock at the time of index evaluation. The clinical and hemodynamic criteria used to diagnose Cardiogenic Shock will be those as defined in the Society for Cardiovascular Angiography and Interventions clinical expert consensus statement on the classification of cardiogenic shock.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Survival	Percentage of participants alive at analysis time points	1 year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Vascular Complications	Percentage of participants experiencing stroke or need for renal replacement therapy	1 year
Major Adverse Cardiovascular and Cerebrovascular Events	Percentage of participants experiencing myocardial infarction, stroke or heart failure re-hospitalization	1 year
Neurologic Status	Average participant neurologic status, as determined by the Cerebral Performance Category instrument	1 year
Health-related Quality of Life	Average participant health-related quality of life score, using the Rand 36-Item Short Form Survey	1 year

Collaborators and Investigators

• Sponsor: STAVROS G DRAKOS
• Investigators: Principal Investigator: Stavros Drakos, M.D., University of Utah

Study record dates

Study Major Dates

• Study Start (Actual): May 25, 2022
• Primary Completion (Estimated): December 31, 2027
• Study Completion (Estimated): December 31, 2027

Study Registration Dates

• First Submitted: December 22, 2021
• First Submitted That Met QC Criteria: December 22, 2021
• First Posted (Actual): January 11, 2022

Study Record Updates

• Last Update Posted (Actual): December 28, 2023
• Last Update Submitted That Met QC Criteria: December 27, 2023
• Last Verified: December 1, 2023

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Ischemia; Pathologic Processes; Necrosis; Myocardial Ischemia; Heart Diseases; Cardiovascular Diseases; Vascular Diseases; Myocardial Infarction; Infarction; Shock; Shock, Cardiogenic
• Other Study ID Numbers: IRB_00148867

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No