Internal Medicine Resident Winnipeg, Manitoba, Canada
Disclosure(s):
Ayelen Rodriguez Portelles, PGY2: No financial relationships to disclose
Background: Cardiogenic shock is a multifactorial disease that clinicians struggle to diagnose and intervene early. One of the biggest hurdles in this diagnosis is the lack of early blood biomarkers. Studies have shown there is a rapid metabolomic shift in patients presenting with acute myocardial infarction undergoing coronary angioplasty.
Methods: Blood samples from a cohort of 259 patients who presented with STEMI were collected at 3 timepoints: pre-intervention, immediately post-intervention, and 24 hours post-intervention. Plasma-oxidized lipids were extracted from these samples. Patients were allocated to the study (cardiogenic shock stage C) and control groups for comparison of differences in the concentration of plasma oxidized lipids. The primary outcome was to determine the plasma lipidomic changes in patients presenting with STEMI-CS.
Outcome: Thirty fragmented Plasma Oxidized Lipids were identified, including Phosphatidylcholine (OxPCs), Phosphatidylinositol (OxPI) and Phosphatidylethanolamine (OxPE) species. OxPCs were the most abundant, presenting the highest values PONPC, followed by POVPC. All the levels increased 24 hours post-intervention. In most instances, levels of total OxPCs in patients with STEMI were not significantly different immediately post-reperfusion; however, there were statistically significant differences in the levels of nineteen different OxPCs 24 hours post-intervention, including POVPC (2.02 ±1.27 vs 2.56 ± 1.56, p=0.0002) and PONPC (13.34 ±8.05 vs 16.95±9.72, p=0.0000). There were no differences in the concentration of OxPCs analyzed to date at baseline or 24 post-intervention between patients from the control and study group. The number of patients with dyslipidemia was significantly elevated in the control group (65% vs 50 %, p = 0.014). Patients who presented with Stage C Cardiogenic Shock had twice as long hospital stays as patients from the control group, with a hospital mortality of 13.8% compared to 1.4% (p=0.0011). 30-day mortality and 1-year MACE differences were also statistically significant between groups (14.6% vs 1.4%, p = 0.00057; 29.2 vs 14.7 p=0.0044).
Conclusion: There are significant changes in the levels of OxPCs in patients with STEMI before intervention compared to 24 hours after intervention. There were no differences in the concentration of OxPCs at baseline or 24 post-intervention. Patients who presented with cardiogenic shock had a significantly prolonged hospital stay and mortality.
