The MARPELLA risk score for prediction of mortality in all-cause refractory cardiogenic shock treated with microaxial transvalvular pump: the MARPELLA study

Abstract Background Although Impella may serve as an alternative strategy in order to stabilize the heart function without detrimental effects of catecholamines or bridge patients definite therapies setting cardiogenic shock (CS), leading a widespread use this device, data concerning reliable prediction predefining which would benefit from implantation such device are completely lacking. Purpose To evaluate and compare prognostic accuracy Acute-Physiology-And-Chronic-Health II (APACHE II), Simplified-Acute-Physiology-Score (SAPS Sepsis-related-organ-failure-assessment (SOFA), intra-aortic-balloon-pump (IABP), CardShock Score refractory CS treated with 2.5/CP. Moreover, we aimed assess prediction-of-Cardiogenic-shock-Outcome-foR-AMI-patients-salvaGed by VA-ECMO (ENCOURAGE) Survival-after -Veno-Arterial-extracorporeal-membranoxygenation (VA-ECMO) (SAVE) score, though initially for created, well develop new score setting. Methods Single center study consecutive admitted Cardiology department our university, February 2013 until December 2020. Results A total 401 were included analysis. 31% supported CP, whereas 153 (38,1%) resuscitated prior admission. Causes was acute myocardial infarction 311 (77,5%) patients, followed dilatative cardiomyopathy/myocarditis (11,1%) aortic stenosis (6%). The expected mortality according scores was: SOFA 50%, SAPS 70%, IABP Shock 55%, 60%, APACHE 65%, ENCOURAGE 75% SAVE 70%. We observed survival 48,9% on hospital discharge 45,6% after 12 months follow-up. Among traditional estimated, most effective predictive model outcome presenting moderate area under curve (AUC) 0.72, CardShock, derived AUC 0,7. II, SOFA, failed predict According main predictors population univariate analysis (vasoactive >31, lactate>4,7 mmol/l, pH<7,31, Creatinine>1,33 mg/dl, Horowitz Index<238, age>71 years resuscitation) odds ratio binary regression mortality, MARPELLA created. This reached 0.83 (Figure 1). 37%, 62% 83,2% low-, intermediate high-risk group respectively 2). Conclusion is more potent all-cause that guide clinicians optimize therapy outweighing intensive care unit scores. Funding Acknowledgement Type funding sources: None.