The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Mechanical Circulatory Support-Assisted Early Percutaneous Coronary Intervention in Acute Myocardial Infarction with Cardiogenic Shock: 10-Year National Temporal Trends, Predictors and Outcomes

DOI: 10.4244/EIJ-D-19-00226

1. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States
2. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
3. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
4. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
5. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
6. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
7. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
8. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
9. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
10. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
11. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
12. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
13. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
14. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
15. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Aims: There are limited data on the trends and outcomes of mechanical circulatory support (MCS)-assisted early percutaneous coronary intervention (PCI) in acute myocardial infarction with cardiogenic shock (AMI-CS). 

Methods and results: Using the National Inpatient Sample database from 2005-2014 a retrospective cohort of AMI-CS admissions receiving early PCI (hospital day zero) was identified. MCS use was defined as intra-aortic balloon pump (IABP), percutaneous left ventricular assist device (pLVAD) and extra-corporeal membrane oxygenation (ECMO) support. Outcomes of interest included in-hospital mortality, resource utilization, trends and predictors of MCS-assisted PCI. Of the 110,452 admissions, MCS assistance was used in 55%. IABP, pLVAD and ECMO were used in 94.8%, 4.2% and 1% respectively. During 2009-2014, there was a decrease in MCS-assisted PCI due to a decrease in IABP, despite an increase in pLVAD and ECMO. Younger age, male sex, lower comorbidity, and cardiac arrest independently predicted MCS use. MCS-assisted PCI was predictive of higher in-hospital mortality (31% vs. 26%, adjusted odds ratio 1.23 [1.19-1.27]; p<0.001) and greater resource utilization. IABP-assisted PCI had lower in-hospital mortality and lesser resource utilization compared to pLVAD/ECMO. 

Conclusions: MCS-assisted PCI identified a sicker AMI-CS cohort. There was a decrease in IABP and an increase in the pLVAD/ECMO.

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