First, the quality of virtual meetings continues to improve over the last year. SCAI 2021 Virtual was no exception. The program was well organized, had a functional app, and minimized overlap. There were discussion sessions that allowed reasonable interaction, making many aspects of the meeting closer to “normal.” From pure scientific dissemination, the meeting was very successful and provided an opportunity for real-time learning for persons who traditionally would be unable to directly participate.
All that accepted, I likely speak for most of us who still long for the opportunity for the merits of “live” interaction. The opportunity to meet and greet friends, informally chat about trials, and how we are incorporating learning into patient care, education, and research “back home” in our local institutions. I can certainly hope that in the not-too-distant future we will be able to integrate the science again with the benefits of human interaction. Likely going forward, a hybrid version of conferences will exist which will sustain dissemination of science to a more diverse and extended audience.
Now to the featured clinical science from Day 1, which focused on management of acute coronary syndromes and cardiogenic shock. Here are summaries of selected presentations.
Update on the North American COVID-19 Myocardial Infarction (NACMI) Registry
Presenter: Payam Dehghani
The NACMI Registry represents a prospective registry organized by three societies to assess the unique aspects of STEMI in the setting of COVID-19 using a historically matched cohort. A recent publication (1) provides an in-depth review through December 2020 of more than 1,000 COVID-19 patients presenting with STEMI. Take home messages include: patients were more likely to include Hispanic and Black minorities, diabetes was a risk factor, and patients were more likely to receive initial medical therapy. Nearly 25% had no lesion on angiography but a majority underwent successful PCI reperfusion. A composite endpoint of death, stroke, repeat MI and/or late revascularization was significantly higher in the COVID-MI group.
Final Results from The National Cardiogenic Shock Initiative
Presenter: Babar Basir
The National Cardiogenic Shock Initiative is a multi-center study (2) aimed at assessing the potential effect of early mechanical circulatory support by initiating an Impella pVAD for patients presenting with an acute myocardial infarction complicated by cardiogenic shock (AMICS) undergoing percutaneous coronary intervention for acute reperfusion. The goal was to initiate MCS within 90 minutes (door to support time) followed by primary PCI. All patients analyzed were SCAI Shock Stage C/D (73%) or Stage E (27%). The results included 406 patients enrolled from 73 sites over 4 years. Overall patient survival for Stage C/D Shock was 99% post procedure, 79% at discharge, while survival for Stage E patients was 99% post procedure but only 49% at discharge. Compared to prior shock studies with a historically average 50% survival for all patients, these data are encouraging and support proceeding to a randomized study to confirm the advantage of an early unloading strategy to reduce mortality in the setting of AMICS.
SCAI Shock Classification for Mortality Risk Stratification: Summary of Published Evidence
Presenter: Jacob C. Jentzer
The SCAI Shock Stages were developed to allow better categorization of the severity of patients preventing with an acute ACS event. The goal was to assess to what extent the classification correlates with mortality by classification to assess the potential reliability of the SCAI Shock Stages to determine mortality. A PubMed search identified 15 articles covering more than 15,000 patients describing at least 7 SCAI Shock definitions. (3) An analysis of the articles demonstrates a stepwise increased mortality risk based on escalating levels of shock. These results support the validity of the SCAI Shock definitions, demonstrating a stepwise increase in mortality for rising shock stages. The information form this review will support limited, future revisions to the shock diagnostic scheme which will be presented at SCAI Shock 2021.
1. Garcia S et al. J Am Coll Cardiol 2021;77:1994–2003.
2. Basir B et al. SCAI Virtual 2021
3. Jentzer J On behalf of the SCAI Shock Classification Update writing group SCAI Virtual 2021