Troponin for predicting Weaning failure from temporary mechanical circulatory support in Infarction complicated by Cardiogenic Shock (TWICS)

<title>Abstract</title> <p>Background: Although several risk-stratification models have been developed for patients with refractory cardiogenic shock requiring temporary mechanical circulatory support, most primarily predict short- and long-term mortality and do not reliably identify patients who can be successfully weaned from support. Cardiac troponin is routinely measured during the acute phase of myocardial infarction. Cumulative troponin exposure, quantified by the troponin area under the concentration–time curve (T-AUC), correlates with the extent of myocardial necrosis. The objective of this study was to evaluate whether T-AUC could improve prediction of temporary mechanical circulatory support weaning failure. Methods: We conducted a single-centre retrospective cohort study including consecutive adults admitted to our cardiac intensive care unit between January 2014 and September 2025 with acute myocardial infarction-related cardiogenic shock requiring temporary mechanical circulatory support. From serial daily troponin I measurements, cumulative troponin exposure was reconstructed as T-AUC. The primary endpoint was temporary mechanical circulatory support weaning failure, defined as death, durable mechanical circulatory support, or heart transplantation during support or within 30 days after explantation. Results: Among the 159 included patients, 97 (61.0%) reached the primary endpoint. In the adjusted time-dependent Cox model, higher cumulative troponin exposure was independently associated with temporary mechanical circulatory support weaning failure (hazard ratio [HR] 1.40 per 1,000,000 ng/L·day increase, 95% confidence interval [CI] 1.19–1.65; p &lt; 0.0001). Restoration of TIMI 3 flow after revascularisation was associated with a significantly lower risk of failure (HR 0.50, 95% CI 0.31–0.80; p = 0.004). Addition of day-5 T-AUC to the clinical model provided the greatest improvement in discrimination (AUC 0.862, 95% CI 0.797–0.926), followed by peak troponin (AUC 0.848, 95% CI 0.779–0.918). Conclusions: In patients with acute myocardial infarction-related cardiogenic shock requiring temporary mechanical circulatory support, cumulative troponin exposure, quantified by T-AUC, was independently associated with failure to wean from support and provided incremental predictive value beyond established clinical risk factors.</p>