Predictors of survival and ability to wean from short-term mechanical circulatory support device following acute myocardial infarction complicated by cardiogenic shock

A. Reshad Garan, Christina Eckhardt, Koji Takeda, Veli K. Topkara, Kevin Clerkin, Justin Fried, Amirali Masoumi, Ryan T. Demmer, Pauline Trinh, Melana Yuzefpolskaya, Yoshifumi Naka, Dan Burkhoff, Ajay Kirtane, Paolo C. Colombo, Hiroo Takayama

Research output: Contribution to journalArticle

11 Scopus citations

Abstract

BACKGROUND:: Cardiogenic shock following acute myocardial infarction (AMI-CS) portends a poor prognosis. Short-term mechanical circulatory support devices (MCSDs) provide hemodynamic support for patients with cardiogenic shock but predictors of survival and the ability to wean from short-term MCSDs remain largely unknown. METHODS:: All patients > 18 years old treated at our institution with extra-corporeal membrane oxygenation or short-term surgical ventricular assist device for AMI-CS were studied. We collected acute myocardial infarction details with demographic and hemodynamic variables. Primary outcomes were survival to discharge and recovery from MCSD (i.e. survival without heart replacement therapy including durable ventricular assist device or heart transplant). RESULTS:: One hundred and twenty-four patients received extra-corporeal membrane oxygenation or short-term surgical ventricular assist device following acute myocardial infarction from 2007 to 2016; 89 received extra-corporeal membrane oxygenation and 35 short-term ventricular assist device. Fifty-five (44.4%) died in the hospital and 69 (55.6%) survived to discharge. Twenty-six (37.7%) required heart replacement therapy (four transplant, 22 durable ventricular assist device) and 43 (62.3%) were discharged without heart replacement therapy. Age and cardiac index at MCSD implantation were predictors of survival to discharge; patients over 60 years with cardiac index <1.5 l/min per m2 had a low likelihood of survival. The angiographic result after revascularization predicted recovery from MCSD (odds ratio 9.00, 95% confidence interval 2.45-32.99, p=0.001), but 50% of those optimally revascularized still required heart replacement therapy. Cardiac index predicted recovery from MCSD among this group (odds ratio 4.06, 95% confidence interval 1.45-11.55, p=0.009). CONCLUSION:: Among AMI-CS patients requiring short-term MCSDs, age and cardiac index predict survival to discharge. Angiographic result and cardiac index predict ventricular recovery but 50% of those optimally revascularized still required heart replacement therapy.

Original languageEnglish (US)
Pages (from-to)755-765
Number of pages11
JournalEuropean heart journal. Acute cardiovascular care
Volume7
Issue number8
DOIs
StatePublished - Dec 1 2018
Externally publishedYes

Keywords

  • ECMO
  • Myocardial infarction
  • cardiogenic shock
  • mechanical circulatory support
  • recovery
  • ventricular assist device

Fingerprint Dive into the research topics of 'Predictors of survival and ability to wean from short-term mechanical circulatory support device following acute myocardial infarction complicated by cardiogenic shock'. Together they form a unique fingerprint.

  • Cite this

    Garan, A. R., Eckhardt, C., Takeda, K., Topkara, V. K., Clerkin, K., Fried, J., Masoumi, A., Demmer, R. T., Trinh, P., Yuzefpolskaya, M., Naka, Y., Burkhoff, D., Kirtane, A., Colombo, P. C., & Takayama, H. (2018). Predictors of survival and ability to wean from short-term mechanical circulatory support device following acute myocardial infarction complicated by cardiogenic shock. European heart journal. Acute cardiovascular care, 7(8), 755-765. https://doi.org/10.1177/2048872617740834