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

Published on Feb 5, 2021in Eurointervention6.534
· DOI :10.4244/EIJ-D-19-00226
Saraschandra Vallabhajosyula10
Estimated H-index: 10
(Mayo Clinic),
Abhiram Prasad73
Estimated H-index: 73
+ 10 AuthorsGregory W. Barsness41
Estimated H-index: 41
Sources
Abstract
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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#1Saraschandra Vallabhajosyula (Wake Forest University)H-Index: 3
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#1Luca BaldettiH-Index: 14
#2Matteo Pagnesi (University of Brescia)H-Index: 1
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#1Saraschandra Vallabhajosyula (Wake Forest University)H-Index: 3
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ABSTRACT Objective To evaluate the prevalence and impact of respiratory infections in cardiogenic shock complicating acute myocardial infarction (AMI-CS). Methods Using the National Inpatient Sample (2000-2017), this study identified adult (≥18 years) admitted with AMI-CS complicated by respiratory infections. Outcomes of interest included in-hospital mortality of AMI-CS admissions with and without respiratory infections, hospitalization costs, hospital length of stay, and discharge disposition....
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