Elderly people frequently have clonal hematopoiesis of indeterminate potential (CHIP) raises their risk for cardiovascular disease as well as hematologic cancers. It was unclear how CHIP may affect the prognosis of individuals with acute myocardial infarction (AMI) accompanying cardiogenic shock (CS). For a study, researchers sought to assess the predictive significance of CHIP in CS following AMI.

In the CULPRIT-SHOCK (Culprit Lesion Only versus Multivessel Percutaneous Coronary Intervention in Cardiogenic Shock) experiment, blood samples were taken randomly from 446 participants. The primary outcome at 30 days was all-cause mortality and renal replacement treatment. CHIP was evaluated using a next-generation sequencing technique that targeted the most frequently mutated genes.

CHIP variations at ≥2% variable allele frequency were found in 29% of cases (n = 129), most often in the DNMT3A or TET2 genes, which, respectively, included 47% and 36% of all mutations. CHIP carriers reported higher levels of N-terminal pro-B-type natriuretic peptide and inflammatory biomarkers, impaired renal function, and were older than non-CHIP patients. Carriers of the CHIP gene had poorer short-term outcomes, as defined by death or by the clinical endpoint of both mortality and severe renal failure within 30 days. While all-cause mortality (OR: 1.67; 95% CI: 0.96-2.90; P = 0.069) was not significantly correlated with the association of CHIP with the composite endpoint, it was independent of age and biomarkers representing renal function, heart failure severity, and inflammation (OR: 1.83; 95% CI: 1.05-3.21; P = 0.03).

CHIP was common in patients with AMI and CS and was linked to a worsened clinical outcome. CHIP evaluation may make risk categorization for CS patients easier and provide new treatment goals.

Reference: jacc.org/doi/10.1016/j.jacc.2022.08.740