{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T17:34:29Z","timestamp":1793036069148,"version":"4.5.0"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Interventions"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Microaxial flow pump (mAFP) use in selected patients with ST-segment\u2013elevation myocardial infarction complicated by cardiogenic shock improves survival. The present study aimed to assess the influence of delay from first symptoms to randomization on the benefit of an mAFP in patients with ST-segment\u2013elevation myocardial infarction complicated by cardiogenic shock.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>This was a secondary analysis of the international, multicenter, randomized, open-labeled DanGer Shock trial (Danish-German Cardiogenic Shock). A total of 345 of 355 patients with ST-segment\u2013elevation myocardial infarction and cardiogenic shock were enrolled in this substudy. Patients were stratified into quartiles according to delay from first symptoms to randomization to either an mAFP or standard care alone. The end point was death from any cause at 180 days for treatment with an mAFP versus standard of care, according to time from onset of symptoms to randomization obtained by logistic regression analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Mortality at 180 days increased across quartiles of time from onset of symptoms to randomization: Q1 (0\u2013140 minutes), 36%; Q2 (141\u2013248 minutes), 53%; Q3 (249\u2013650 minutes), 59%; and Q4 (&gt; 651 minutes), 62%, respectively (log-rank\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.002). However, those with longer delays were also older and more often women. Median age rose from 66 years (interquartile range, 57\u201373) in the earliest quartile to 71 years (interquartile range, 62\u201379) in the latest quartile (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.005), and the proportion of women increased from 15% to 34%, respectively. Combining the 3 lowest quartiles for the time from onset of symptoms to randomization, the mAFP treatment was associated with an odds ratio of 0.51 (95% CI, 0.31\u20130.84), whereas the odds ratio for the highest quartile was 0.92 (95% CI, 0.38\u20132.22;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      for interaction = 0.26).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>In patients with ST-segment\u2013elevation myocardial infarction complicated with cardiogenic shock, treatment with an mAFP was associated with reduced all-cause mortality, but the treatment benefit appeared to weaken with prolonged time from the onset of symptoms to randomization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT01633502.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circinterventions.125.015718","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T10:00:14Z","timestamp":1768212014000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Delay From First Symptoms in Patients Presenting With STEMI and Cardiogenic Shock: Insights From the DanGer Shock Trial"],"prefix":"10.1161","volume":"19","clinical-trial-number":[{"clinical-trial-number":"nct01633502","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4838-2429","authenticated-orcid":true,"given":"Lisette Okkels","family":"Jensen","sequence":"first","affiliation":[{"name":"Department of Cardiology (L.O.J., K.W., N.L.J.U., A.J.), Odense University Hospital, Denmark."},{"name":"Department of Clinical Research, University of Southern Denmark, Odense (L.O.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5880-3733","authenticated-orcid":true,"given":"Rasmus Paulin","family":"Beske","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Copenhagen University Hospital \u2013 Rigshospitalet, Denmark (R.P.B., L.H., T.E., C.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans","family":"Eiskj\u00e6r","sequence":"additional","affiliation":[{"name":"Department of Cardiology (H.E.\u00e6r, C.J.T.), Aarhus University Hospital, Denmark."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0793-7923","authenticated-orcid":true,"given":"Norman","family":"Mangner","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universit\u00e4t Dresden, Germany (N.M., A.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5891-9672","authenticated-orcid":true,"given":"Amin","family":"Polzin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Pulmonology and Vascular Medicine, University Hospital D\u00fcsseldorf, Medical Faculty of the Heinrich Heine University D\u00fcsseldorf, Germany (A.P.)."},{"name":"Cardiovascular Research Institute D\u00fcsseldorf (CARID), Germany (A.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9442-7141","authenticated-orcid":true,"given":"P. Christian","family":"Schulze","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Cardiology, Angiology and Intensive Medical Care, University Hospital Jena, Germany (P.C.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carsten","family":"Skurk","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charit\u00e9, Campus Benjamin Franklin, Berlin, Germany (C.S.)."},{"name":"Deutsches Zentrum f\u00fcr Herz-Kreislauf-Forschung e.V., Berlin, Germany (C.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2560-4068","authenticated-orcid":true,"given":"Peter","family":"Nordbeck","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, University Hospital W\u00fcrzburg, Germany (P.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9529-8388","authenticated-orcid":true,"given":"Peter","family":"Clemmensen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Heart and Vascular Center (UHZ), University Clinic Hamburg \u2013 Eppendorf (UKE), Center for Population Health Research (POINT), Germany (P.C.)."},{"name":"Department of Cardiology, Zealand University Hospital, Roskilde and Nyk\u00f8bing Falster, Denmark (P.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9894-9200","authenticated-orcid":true,"given":"Vasileios","family":"Panoulas","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy\u2019s and St. Thomas\u2019 NHS Foundation Trust, Harefield Hospital, United Kingdom (V.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1531-2088","authenticated-orcid":true,"given":"Sebastian","family":"Zimmer","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital Bonn, Germany (S.Z.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3206-6162","authenticated-orcid":true,"given":"Andreas","family":"Sch\u00e4fer","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology, Hannover Medical School, Germany (A.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikos","family":"Werner","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Br\u00fcder, Germany (N.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lene","family":"Holmvang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Copenhagen University Hospital \u2013 Rigshospitalet, Denmark (R.P.B., L.H., T.E., C.H.)."},{"name":"Department of Clinical Medicine, University of Copenhagen, Denmark (L.H., T.E., C.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5861-1478","authenticated-orcid":true,"given":"Kristian","family":"Wachtell","sequence":"additional","affiliation":[{"name":"Department of Cardiology (L.O.J., K.W., N.L.J.U., A.J.), Odense University Hospital, Denmark."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5436-9194","authenticated-orcid":true,"given":"Thomas","family":"Engst\u00f8m","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Copenhagen University Hospital \u2013 Rigshospitalet, Denmark (R.P.B., L.H., T.E., C.H.)."},{"name":"Department of Clinical Medicine, University of Copenhagen, Denmark (L.H., T.E., C.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1542-3260","authenticated-orcid":true,"given":"Nanna Louise Junker","family":"Udesen","sequence":"additional","affiliation":[{"name":"Department of Cardiology (L.O.J., K.W., N.L.J.U., A.J.), Odense University Hospital, Denmark."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1080-3344","authenticated-orcid":true,"given":"Henrik","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care (H.S.), Odense University Hospital, Denmark."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"Junker","sequence":"additional","affiliation":[{"name":"Department of Cardiology (L.O.J., K.W., N.L.J.U., A.J.), Odense University Hospital, 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