Study Looks at 10-Year Trends of Mechanical Circulatory Support in PCI for Acute MI With Cardiogenic Shock

February 4, 2021—In EuroIntervention, findings from a 10-year retrospective cohort assessment of mechanical circulatory support (MCS) in percutaneous coronary intervention (PCI) for acute myocardial infarction with cardiogenic shock (AMI-CS) were published by Saraschandra Vallabhajosyula, MD, et al (2021;16:e1254-e1261).

The study used the National Inpatient Sample database from 2005-2014 to assess the use, temporal trends, predictors, and outcomes of percutaneous MCS-assisted early PCI in AMI-CS.

As summarized in EuroIntervention, the investigators identified a retrospective cohort of AMI-CS admissions receiving early PCI (hospital day zero). 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 utilization, trends, and predictors of MCS-assisted PCI.

Of the 110,452 admissions, MCS assistance was used in 55% of patients. IABP, pLVAD, and ECMO were used in 94.8%, 4.2%, and 1% of patients, respectively.

The investigators reported the following in EuroIntervention:

• During 2009-2014, there was a decrease in MCS-assisted PCI because of 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 < .001) and greater resource utilization.
• IABP-assisted PCI had lower in-hospital mortality and lesser resource utilization compared to pLVAD/ECMO.

In conclusion, MCS-assisted PCI identified a sicker AMI-CS cohort; there was a decrease in IABP; and there was an increase in pLVAD/ECMO use, concluded the investigators in EuroIntervention.