Outcomes with Temporary Mechanical Circulatory Support Devices during Acute Myocardial Infarction Cardiogenic Shock

Abstract

Although various temporary mechanical circulatory support devices are utilized during acute myocardial infarction cardiogenic shock (AMI CS), comparisons of interdevice outcomes remain uncertain. We sought to determine patient characteristics and outcomes between venoarterial extracorporeal membrane oxygenation (VA ECMO) and Impella supported patients during AMI CS. A single center retrospective study was conducted in consecutive patients with AMI CS from 02/12 to 09/19. Patients were grouped and analyzed by their initially assigned device as either VA ECMO or Impella. Device crossover was censored. Severity of illness was compared by sequential organ failure assessment (SOFA) and Vasoactive Inotropic Score (VIS). Thirty day survival and a composite of adverse neurologic (ischemic stroke and intracranial hemorrhage), thromboembolic and major bleeding events were compared between devices by Kaplan Meier analysis. One hundred and twelve patients with AMI CS underwent VA ECMO (n=57) or Impella (n=55) placement. Patients with VA ECMO had higher SOFA (15.0 IQR: 11.5-18.0 vs. 8.0 IQR: 5.0-13.0, p<0.001) and VIS (310.00 IQR: 18.75-459.25 vs. 10.00 IQR: 20-445.00 p<0.001). Thirty-four (59.6%) VA ECMO patients had CPR in comparison to 25 (45.5%) on Impella (p=0.135). Duration of support was greater for VA ECMO (118.0 IQR: 48.0-190.0 vs. 48.0 IQR: 24.0-97.0 hours, p=0.001) than Impella. Thirty-day survival was similar between VA ECMO (40%) and Impella (49%, p=0.65, Figure 1). More VA ECMO patients incurred a composite of adverse events (46% vs. 18%, p=0.03) during device support. Seven (12%) patients on VA ECMO eventually received Impella while 17 (31%) with an initial Impella needed VA ECMO. Despite a higher severity of illness, AMI CS patients experienced similarly limited survival with VA ECMO or Impella. More adverse events occurred during VA ECMO support. Larger studies are warranted for optimal device selection during AMI CS.