Escalation strategies, management, and outcomes of acute myocardial infarction-cardiogenic shock patients receiving percutaneous left ventricular support
© 2023 Wiley Periodicals LLC..
BACKGROUND: There are limited national-level data on the contemporary practices of mechanical circulatory support (MCS) use in acute myocardial infarction-cardiogenic shock (AMI-CS).
METHODS: We utilized the Healthcare Cost and Utilization Project-National/Nationwide Inpatient Sample data (2005-2017) to identify adult admissions (>18 years) with AMI-CS. MCS devices were classified as intra-aortic balloon pump (IABP), percutaneous left ventricular assist devices (pLVAD), or extracorporeal membrane oxygenation (ECMO). We evaluated trends in the initial device used (IABP alone, pLVAD alone or ≥2 MCS devices), device escalation, bridging to durable LVAD/heart transplantation, and predictors of in-hospital mortality and device escalation.
RESULTS: Among 327,283 AMI-CS admissions, 131,435 (40.2%) had an MCS device placed with available information on timing of placement. IABP, pLVAD, and ≥2 MCS devices were used as initial device in 120,928 (92.0%), 8202 (6.2%), and 2305 (1.7%) admissions, respectively. Most admissions were maintained on the initial MCS device with 1%-1.5% being escalated (IABP to pLVAD/ECMO, pLVAD to ECMO). Urban, medium, and large-sized hospitals and acute multiorgan failure were significant independent predictors of MCS escalation. In admissions receiving MCS, escalation of MCS device was associated with higher in-hospital mortality (adjusted odds ratio: 1.56, 95% confidence interval: 1.38-1.75; p < 0.001). Admissions receiving durable LVAD/heart transplantation increased over time in those initiated on pLVAD and ≥2 MCS devices, resulting in lower in-hospital mortality.
CONCLUSIONS: In this 13-year study, escalation of MCS in AMI-CS was associated with higher in-hospital mortality suggestive of higher acuity of illness. The increase in number of durable LVAD/heart transplantations alludes to the role of MCS as successful bridge strategies.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:102 |
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| Enthalten in: |
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions - 102(2023), 3 vom: 18. Sept., Seite 403-414 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Patlolla, Sri Harsha [VerfasserIn] |
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| Links: |
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| Themen: |
Acute myocardial infarction |
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| Anmerkungen: |
Date Completed 12.09.2023 Date Revised 12.09.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1002/ccd.30786 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM359738567 |
|---|
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| 100 | 1 | |a Patlolla, Sri Harsha |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Escalation strategies, management, and outcomes of acute myocardial infarction-cardiogenic shock patients receiving percutaneous left ventricular support |
| 264 | 1 | |c 2023 | |
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| 500 | |a Date Completed 12.09.2023 | ||
| 500 | |a Date Revised 12.09.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2023 Wiley Periodicals LLC. | ||
| 520 | |a BACKGROUND: There are limited national-level data on the contemporary practices of mechanical circulatory support (MCS) use in acute myocardial infarction-cardiogenic shock (AMI-CS) | ||
| 520 | |a METHODS: We utilized the Healthcare Cost and Utilization Project-National/Nationwide Inpatient Sample data (2005-2017) to identify adult admissions (>18 years) with AMI-CS. MCS devices were classified as intra-aortic balloon pump (IABP), percutaneous left ventricular assist devices (pLVAD), or extracorporeal membrane oxygenation (ECMO). We evaluated trends in the initial device used (IABP alone, pLVAD alone or ≥2 MCS devices), device escalation, bridging to durable LVAD/heart transplantation, and predictors of in-hospital mortality and device escalation | ||
| 520 | |a RESULTS: Among 327,283 AMI-CS admissions, 131,435 (40.2%) had an MCS device placed with available information on timing of placement. IABP, pLVAD, and ≥2 MCS devices were used as initial device in 120,928 (92.0%), 8202 (6.2%), and 2305 (1.7%) admissions, respectively. Most admissions were maintained on the initial MCS device with 1%-1.5% being escalated (IABP to pLVAD/ECMO, pLVAD to ECMO). Urban, medium, and large-sized hospitals and acute multiorgan failure were significant independent predictors of MCS escalation. In admissions receiving MCS, escalation of MCS device was associated with higher in-hospital mortality (adjusted odds ratio: 1.56, 95% confidence interval: 1.38-1.75; p < 0.001). Admissions receiving durable LVAD/heart transplantation increased over time in those initiated on pLVAD and ≥2 MCS devices, resulting in lower in-hospital mortality | ||
| 520 | |a CONCLUSIONS: In this 13-year study, escalation of MCS in AMI-CS was associated with higher in-hospital mortality suggestive of higher acuity of illness. The increase in number of durable LVAD/heart transplantations alludes to the role of MCS as successful bridge strategies | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a acute myocardial infarction | |
| 650 | 4 | |a cardiogenic shock | |
| 650 | 4 | |a mechanical circulatory support | |
| 650 | 4 | |a outcomes research | |
| 650 | 4 | |a practice patterns | |
| 700 | 1 | |a Gilbert, Olivia N |e verfasserin |4 aut | |
| 700 | 1 | |a Belford, Peter M |e verfasserin |4 aut | |
| 700 | 1 | |a Morris, Benjamin N |e verfasserin |4 aut | |
| 700 | 1 | |a Jentzer, Jacob C |e verfasserin |4 aut | |
| 700 | 1 | |a Pisani, Barbara A |e verfasserin |4 aut | |
| 700 | 1 | |a Applegate, Robert J |e verfasserin |4 aut | |
| 700 | 1 | |a Zhao, David X |e verfasserin |4 aut | |
| 700 | 1 | |a Vallabhajosyula, Saraschandra |e verfasserin |4 aut | |
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