scholarly journals Racial Disparities in the Utilization and Outcomes of Temporary Mechanical Circulatory Support for Acute Myocardial Infarction-Cardiogenic Shock

2021 ◽  
Vol 10 (7) ◽  
pp. 1459
Author(s):  
Rahul Vojjini ◽  
Sri Harsha Patlolla ◽  
Wisit Cheungpasitporn ◽  
Arnav Kumar ◽  
Pranathi R. Sundaragiri ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Hospital Stay ◽  
Racial Disparities ◽  
Mechanical Circulatory Support ◽  
Left Ventricular ◽  
Hospital Length Of Stay ◽  
Circulatory Support

Racial disparities in utilization and outcomes of mechanical circulatory support (MCS) in patients with acute myocardial infarction-cardiogenic shock (AMI-CS) are infrequently studied. This study sought to evaluate racial disparities in the outcomes of MCS in AMI-CS. The National Inpatient Sample (2012–2017) was used to identify adult AMI-CS admissions receiving MCS support. MCS devices were classified as intra-aortic balloon pump (IABP), percutaneous left ventricular assist device (pLVAD) or extracorporeal membrane oxygenation (ECMO). Self-reported race was classified as white, black and others. Outcomes included in-hospital mortality, hospital length of stay and discharge disposition. During this period, 90,071 admissions were included with white, black and other races constituting 73.6%, 8.3% and 18.1%, respectively. Compared to white and other races, black race admissions were on average younger, female, with greater comorbidities, and non-cardiac organ failure (all p < 0.001). Compared to the white race (31.3%), in-hospital mortality was comparable in black (31.4%; adjusted odds ratio (aOR) 0.98 (95% confidence interval (CI) 0.93–1.05); p = 0.60) and other (30.2%; aOR 0.96 (95% CI 0.92–1.01); p = 0.10). Higher in-hospital mortality was noted in non-white races with concomitant cardiac arrest, and those receiving ECMO support. Black admissions had longer lengths of hospital stay (12.1 ± 14.2, 10.3 ± 11.2, 10.9 ± 1.2 days) and transferred less often (12.6%, 14.2%, 13.9%) compared to white and other races (both p < 0.001). In conclusion, this study of AMI-CS admissions receiving MCS devices did not identify racial disparities in in-hospital mortality. Black admissions had longer hospital stay and were transferred less often. Further evaluation with granular data including angiographic and hemodynamic parameters is essential to rule out racial differences.

scholarly journals Mechanical circulatory support with impella in patients with non-acute myocardial infarction related cardiogenic shock

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Haurand ◽  
S Bueter ◽  
C Jung ◽  
M Kelm ◽  
R Westenfeld ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Apache Ii Score ◽  
Hemodynamic Parameters ◽  
Clinical Scores ◽  
Lactate Levels

Abstract Background Percutaneous left ventricular assist devices such as the Impella pump, are used to hemodynamically stabilize patients with cardiogenic shock (CS) caused by acute myocardial infarction (AMI) until cardiac function has recovered after revascularization. Whether Impella mechanical circulatory support (MCS) is effective in stabilizing patients with CS not caused by AMI has so far not been thoroughly investigated. Purpose The aim of this study is to analyze whether MCS with Impella is effective to stabilize patients with non-AMI related CS compared to patients with AMI related CS. Method We retrospectively analyzed 106 patients with CS and Impella support in the years from 2011 to 2018. Efficacy to stabilize the patient was assessed by laboratory values such as lactate, hemodynamic parameters and clinical scores. The difference in mortality was calculated with the Log-Rank-Test, comparing Kaplan-Meier curves. Results 36 patients suffered from non-AMI CS and in 70 patients CS was caused by AMI. Regarding the clinical scores and hemodynamic parameters, both groups were severely ill, with no significant difference in APACHE II score, with a mean score of 17.9 in the non-AMI group compared to 20.5 in the AMI-group (p=0.103), the SOFA score (mean score of 6.3 in non-AMI group vs 6.8 in AMI group, p=0.467) and cardiac index (mean CI of 1.9 l/min/m2 in non-AMI group vs 2.2 l/min/m2 in AMI group, p=0.176). There was a comparable mean decrease in lactate levels in both groups 48 hours after initiation of MCS, from initially 4.1 mmol/l to 1.7 mmol/l (p&lt;0.001) in the non-AMI group and from initially 3.6 mmol/l to 2.2 mmol/l (p=0.025) in the AMI group. The non-ACS group exhibited a trend of lower mortality compared to the AMI group, with 47% in the non-AMI group and 57% in the AMI group (p=0.067). In multivariate analysis, age, lactate levels, cardiopulmonary resuscitation, low platelets and higher doses of inotropes and vasopressors were independent predictors for mortality. An upgrade to LVAD was performed for 22% of the non-AMI group and for 6% of the AMI group (p=0.020). Conclusion Impella support is effective to hemodynamically stabilize patients with non-AMI related CS. Therefore, MCS can be used as bridge to recovery or enables further treatment options as upgrade to longterm mechanical support devices. Funding Acknowledgement Type of funding source: None

scholarly journals Utilization of Percutaneous Mechanical Circulatory Support Devices in Cardiogenic Shock Complicating Acute Myocardial Infarction and High-Risk Percutaneous Coronary Interventions

2019 ◽  
Vol 8 (8) ◽  
pp. 1209 ◽  
Author(s):  
Asleh ◽  
Resar
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
High Risk ◽  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Percutaneous Coronary Interventions ◽  
Coronary Interventions ◽  
Percutaneous Coronary

Given the tremendous progress in interventional cardiology over the last decade, a growing number of older patients, who have more comorbidities and more complex coronary artery disease, are being considered for technically challenging and high-risk percutaneous coronary interventions (PCI). The success of performing such complex PCI is increasingly dependent on the availability and improvement of mechanical circulatory support (MCS) devices, which aim to provide hemodynamic support and left ventricular (LV) unloading to enable safe and successful coronary revascularization. MCS as an adjunct to high-risk PCI may, therefore, be an important component for improvement in clinical outcomes. MCS devices in this setting can be used for two main clinical conditions: patients who present with cardiogenic shock complicating acute myocardial infarction (AMI) and those undergoing technically complex and high-risk PCI without having overt cardiogenic shock. The current article reviews the advancement in the use of various devices in both AMI complicated by cardiogenic shock and complex high-risk PCI, highlights the available hemodynamic and clinical data associated with the use of MCS devices, and presents suggestive management strategies focusing on appropriate patient selection and optimal timing and support to potentially increase the clinical benefit from utilizing these devices during PCI in this high-risk group of patients.

Abstract 17020: Nationwide Analysis to Determine Mechanical Circulatory Support Device Use in Mechanical Complications of Acute Myocardial Infarction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
ayesha shaik ◽  
Karthik Gonuguntla ◽  
Nikola Perosevic
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Reperfusion Therapy ◽  
Circulatory Support ◽  
Cardiac Transplant ◽  
Papillary Muscle Rupture ◽  
Mechanical Complications

Introduction: Without timely reperfusion therapy, acute myocardial infarction (AMI) can lead to mechanical complications (MC) such as papillary muscle rupture (PMR), ventricular septal rupture (VSR), free wall rupture (FWR). Mechanical circulatory support (MCS) devices such as intra-aortic balloon pump (IABP), Impella and extracorporeal membrane oxygenation (ECMO) are used in cardiogenic shock associated with AMI-MC. Hypothesis: As per the SHOCK-II trial use of MCS in MI complicated cardiogenic shock showed no difference in mortality. We sought to determine the rates of AMI-MC, MCS device placements and outcomes associated with them. Methods: The Nationwide Inpatient Sample was queried from 2010 to 2014 using ICD-9 codes with a primary diagnosis of AMI. We also used diagnosis and procedure codes for MC and MCS devices. We excluded patients with NSTEMI. Results: From 2010 to 2014, we identified 3158 hospitalizations related to AMI-MC with a mean age of 64±13.4 years. Majority were men 69% with 75% Caucasian with an in-hospital mortality rate of 37%. Use of MCS was most common in males (67%), Caucasians (77%), and with an age group of 50-70 years (54%). Of these patients, PMR was noted in 13%, VSR in 31% and FWR in 56%. Rates of MCS devices were 38% (IABP 35%, Impella 3% and ECMO 4%). Overall use of MCS for FWR, VSR, PMR were 15%, 61%, 80%. Percentage of MC requiring IABP, Impella, ECMO were as follows; FWR (15%, 0.6%, 0.3%), VSR (58%, 7%, 6%), PMR (70%, 5%, 12%). Patients that received cardiac transplant was 0.2%. In-hospital mortality among patients who received MCS to those who did not receive MCS were 59% vs 24%; p<0.001, among patients who received IABP to those who did not receive any MCS were 54% vs 24%; p<0.001 and among patients who received Impella to no MCS were 86% vs 24%; p<0.001. Conclusions: Based on the results, FWR was the most common MC. MCS were most commonly used in PMR followed by VSR, with IABP being the most common type. Patients on MCS had increased in-hospital mortality compared to those without MCS. Large randomized trials are needed to determine the effectiveness of these devices in predicting outcomes associated with AMI-MC

Mechanical Circulatory Support in Cardiogenic Shock Following an Acute Myocardial Infarction: A Systematic Review

2014 ◽  
Vol 29 (5) ◽  
pp. 743-751 ◽  
Author(s):  
Manuel Caceres ◽  
Fardad Esmailian ◽  
Jaime D. Moriguchi ◽  
Francisco A. Arabia ◽  
Lawrence S. Czer
Keyword(s):  
Myocardial Infarction ◽  
Systematic Review ◽  
Acute Myocardial Infarction ◽  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Circulatory Support
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