Coronary interventions – Mini focus on out-of-hospital cardiac arrest and cardiogenic shock

Ten-year trends, predictors and outcomes of mechanical circulatory support in percutaneous coronary intervention for acute myocardial infarction with cardiogenic shock

EuroIntervention 2021;16:e1254-e1261. DOI: 10.4244/EIJ-D-19-00226

Saraschandra Vallabhajosyula
Saraschandra Vallabhajosyula1, MD; Abhiram Prasad1, MD; Gurpreet S. Sandhu1, MD, PhD; Malcolm R. Bell1, MD; Rajiv Gulati1, MD, PhD; Mackram F. Eleid1, MD; Patricia J.M. Best1, MD; Bernard J. Gersh1, MBChB, DPhil; Mandeep Singh1, MD; Amir Lerman1, MD; David R. Holmes Jr1, MD; Charanjit S. Rihal1, MD; Gregory W. Barsness1, MD
1. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA

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). In this study, we sought to assess the use, temporal trends, and outcomes of percutaneous MCS-assisted early PCI in 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 extracorporeal membrane oxygenation (ECMO) support. Outcomes of interest included in-hospital mortality, resource utilisation, 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 utilisation. IABP-assisted PCI had lower in-hospital mortality and lesser resource utilisation compared to pLVAD/ECMO.

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

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acs/nste-acscardiogenic shockiabpstemiventricular assist device
Coronary interventionsInterventions for heart failureSTEMINSTEMIAcute heart failure
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