Objectives To describe the contemporary trends in the use of mechanical circulatory support (MCS) in patients with acute myocardial infarction and cardiogenic shock (AMICS). To evaluate survival benefit with early application of intra-aortic balloon pump (IABP) or Impella CP.
Methods A cohort study of all consecutive patients with AMICS undergoing percutaneous coronary intervention (PCI) <24 hours of symptom onset (early PCI) in southeastern Denmark from 2010 to 2017. A matched case–control study comparing 30-day mortality between patients receiving early-IABP or early-Impella CP and their respective control group. Controls were matched on age, left ventricular ejection fraction, arterial lactate, estimated glomerular filtration rate and cardiac arrest before PCI. Early-IABP/Impella CP was defined as applied before PCI if shock developed pre-PCI, or immediately after PCI if shock developed during PCI.
Results 903 patients with AMICS undergoing early PCI were identified. Use of MCS decreased from 50% in 2010 to 25% in 2017, p for trend of <0.001. The IABP was abandoned in 2012 and replaced mostly by Impella CP. Patients receiving MCS in 2013–2017 had more compromised haemodynamics compared with patients receiving MCS in 2010–2012. 40 patients received early IABP, and 40 patients received early Impella CP. Only the group receiving early Impella CP was associated with lower 30-day mortality compared with their matched control group (30-day mortality 40% vs 77.5%, plog-rank of<0.001).
Conclusion Use of MCS decreased by 50% from 2010 to 2017. Patients receiving MCS had more compromised haemodynamics in recent years. Early application of Impella CP was associated with reduced 30-day mortality compared with a matched control group.
- cardiogenic shock
- left ventricular assist device
- myocardial ischaemia and infarction (IHD)
- coronary intervention (PCI)
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Contributors Conception and design: OKLH, CH, LOJ, LH, HS, HBR and JEM. Data collection: OKLH, JJ, NLJU, LOJ and LH. Data analysis and interpretation: OKLH, CH, HBR and JEM. Drafting of the article: OKLH, CH, HBR and JEM. Critical revision and final approval: all authors.
Funding This work was supported by the Danish Heart Foundation, the Odense University Hospital/Rigshospitalet Research Fund and a research grant from Abiomed.
Competing interests OKLH and NLJU received travel compensation from Abiomed. JEM received research grants and speaker’s fee from Abiomed.
Patient consent for publication Not required.
Ethics approval This study was approved by the Danish Patient Safety Authority (case number 3-3013-1133/1) and the Danish Data Protection Agency (file number 16/7381 and 18/23756).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request. Deidentified participant data can be made availible upon reasonable request.
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