Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock

Document Type

Article

Publication Date

3-15-2017

Publication Title

The American journal of cardiology

Abstract

The role and timing of percutaneous mechanical circulatory support (MCS) devices in the treatment of acute myocardial infarction complicated by cardiogenic shock (AMICS) are not well understood. We sought to evaluate patient characteristics and predictors of outcomes in patients presenting with AMICS supported with an axial flow percutaneous MCS device; 287 consecutive unselected patients enrolled in the catheter-based ventricular assist device registry presenting with AMICS who underwent percutaneous coronary intervention (PCI) were included in this analysis. All patients were supported with either the Impella 2.5 or Impella CP. Mean patient age was 66 ± 12.5 years, 76% were men, and mean left ventricular ejection fraction was 25 ± 12%. Before receiving MCS, 80% of patients required inotropes or vasopressors and 40% were supported with intra-aortic balloon pump; 9% of patients were under active cardiopulmonary resuscitation at the time of MCS implantation. Survival to discharge was 44%. In a multivariate analysis, early implantation of a MCS device before PCI (p = 0.04) and before requiring inotropes and vasopressors (p = 0.05) was associated with increased survival. Survival was 66% when MCS was initiated

Medical Subject Headings

Aged; Female; Heart-Assist Devices; Hemodynamics; Humans; Male; Middle Aged; Registries; Risk Factors; Shock, Cardiogenic; Survival Rate; Treatment Outcome

PubMed ID

28040188

Volume

119

Issue

6

First Page

845

Last Page

851

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