Mechanical Circulatory Support-Assisted Early Percutaneous Coronary Intervention in Acute Myocardial Infarction with Cardiogenic Shock: 10-Year National Temporal Trends, Predictors and Outcomes.

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.