Genomic Determinants of Outcome in Cardiogenic Shock

Inclusion Criteria

• •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.
• •1. Unwilling to provide informed consent.
• •2. 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.
• •3. Age \<18 and ≥80 years.
• •4. Shock from another cause (sepsis, haemorrhagic/hypovolaemic shock, anaphylaxis, etc).
• •5. Significant systemic illness
• •6. Known dementia of any severity
• •7. Comorbidity with life expectancy \<12 months.
• •8. Out-of-hospital cardiac arrest (OHCA) and any of the following:
• •1. No return of spontaneous circulation (ongoing resuscitation effort)
• •2. pH \<7
• •3. Without bystander CPR within 10 minutes of collapse
• •9. Arterial lactate level of \<2.0 mmol per litre.