Genomic Determinants of Outcome in Cardiogenic Shock

Age

• Any of the inclusion criteria not met and:
  • Unwilling to provide informed consent.
  • Echocardiographic evidence (recorded within 90 mins of end of PCI procedure) of mechanical cause for CS: eg ventricular septal defect, LV-free wall rupture, ischaemic mitral regurgitation.
  • Age \<18 and ≥80 years.
  • Shock from another cause (sepsis, haemorrhagic/hypovolaemic shock, anaphylaxis, etc).
  • Significant systemic illness
  • Known dementia of any severity
  • Comorbidity with life expectancy \<12 months.
  • Out-of-hospital cardiac arrest (OHCA) and any of the following:
  • No return of spontaneous circulation (ongoing resuscitation effort)
  • pH \<7
  • Without bystander CPR within 10 minutes of collapse
  • Arterial lactate level of \<2.0 mmol per litre.

• All of the following are required for inclusion following screening:
  • Willing to provide informed consent or appropriate consent from a nominated consultee or personal consultee
  • Presentation within 24 hours of onset of ACS symptoms.
  • CS can only be secondary to ACS (Type 1 MI STEMI or N-STEMI) or myocarditis
  • Planned or completed revascularisation of culprit coronary artery
  • CS will be defined by:
• Systolic blood pressure \<90 mmHg for at least 30 minutes
• A requirement for a continuous infusion of vasopressor or inotropic therapy to maintain systolic blood pressure \> 90 mmHg.
• Clinical signs of pulmonary congestion, plus signs of impaired organ perfusion with at least one of the following manifestations:
  • altered mental status.
  • cold and clammy skin and limbs.
  • oliguria with a urine output of less than 30 ml per hour.
  • elevated arterial lactate level of \>2.0 mmol per litre.