National Trends and Outcomes of Early versus Delayed Mechanical Circulatory Support in Patients with Acute Myocardial Infarction Complicated by Cardiogenic Shock
Recommended Citation
Buda KG, Hryniewicz K, Eckman PM, Basir MB, Cowger JA, Alaswad K, Mukundan S, Sandoval Y, Elliott A, Brilakis ES, Megaly MS. National Trends and Outcomes of Early versus Delayed Mechanical Circulatory Support in Patients with Acute Myocardial Infarction Complicated by Cardiogenic Shock. US Cardiology Review 2024; 18:3.
Document Type
Conference Proceeding
Publication Date
5-1-2024
Publication Title
US Cardiology Review
Abstract
Background: Despite increased temporary mechanical circulatory support (tMCS) utilization for acute MI complicated by cardiogenic shock (AMI-CS), observational and randomized data regarding tMCS efficacy are conflicting. Objectives: The aim of the study was to describe outcomes based on tMCS timing in AMI-CS and to identify predictors of in-hospital and 30-day mortality and readmission. Methods: Patients with AMI-CS identified in the National Readmissions Database (NRD) were grouped according to the use of tMCS and early (<24 hours) versus delayed tMCS (≥24 hours) utilization. The correlation between the timing of tMCS support and inpatient outcomes was evaluated using linear regression. Multivariate logistic regression (OR [95% CI]) using backward stepwise elimination was used to identify variables associated with 30-day mortality and readmission. Results: Patients who underwent tMCS (n=109,148) for AMI-CS had lower in-hospital mortality (33.9% versus 36.4%, p<0.001), longer lengths of stay (median [IQR]) (9 [4-17] days versus 7 [3-14] days, p<0.001), and twice the hospital cost (US$64,069 [$39,455-$105,441] versus US$31,832 [$17,595- $57,742] p<0.001) compared to those who did not have tMCS (n=185,691) in the unadjusted analysis. Patients who received tMCS within 24 hours of admission (n=79,906) had shorter length of stay (7 days versus 15 days, p<0.001), lower hospital cost (US$55,644 versus US$88,644, p<0.001), and lower rates of ischemic and bleeding complications than those with tMCS placed ≥24 hours after admission (n=32,241). After adjustment, early tMCS was associated with lower mortality (OR 0.92 [CI 0.88-0.96]) and readmission (OR 0.91 [CI 0.85-0.97]). Conclusion: Among patients receiving tMCS for AMI-CS, early tMCS was associated with shorter lengths of stay, lower hospital costs, and fewer deaths and readmissions at 30 days. In AMI-CS, early tMCS may be preferable to delayed tMCS.
Volume
18
First Page
3
