Important role of mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock

Lauren Truby, Yoshifumi Naka, Bindu Kalesan, Takeyoshi Ota, Ajay J. Kirtane, Susheel Kodali, Natasha Nikic, Lily Mundy, Paolo Colombo, Ulrich P. Jorde, Hiroo Takayama

Research output: Contribution to journalArticle

13 Scopus citations

Abstract

OBJECTIVES: Acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) remains associated with significant mortality despite the widespread application of early revascularization strategies. Recent evidence suggests that the use of intra-aortic balloon pump (IABP) counterpulsation does not improve mortality in this cohort of patients. We summarize our experience with mechanical circulatory support (MCS) therapy for AMI/CS. METHODS: This is a retrospective review of 61 patients who received MCS therapy for AMI/CS at our institution between March 2007 and March 2013. RESULTS: Mean age was 60.2 ± 10.3 years; mean ejection fraction was 24 ± 15% and 29% of patients were receiving active cardiopulmonary resuscitation at the time of support initiation. Prior to the initiation of MCS, 70.5% of patients had an IABP. Mean arterial pressure improved significantly with MCS (63 mmHg prior to MCS, 82 mmHg after MCS, P ≤ 0.01). Mean length of support was 9.5 ± 11.0 days, and overall survival to 30 days was 59.0%. Among 30-day survivors, 44.4% required device exchange to a durable MCS device. Ultimately, only 31% (52.8% of patients who survived to 30 days) achieved myocardial recovery. CONCLUSIONS: Short-term MCS therapy with subsequent aggressive use of durable MCS device may improve the unacceptably high mortality rate in AMI/CS. Rigorous prospective studies of MCS therapy in AMI/CS are warranted.

Original languageEnglish (US)
Article numberezu478
Pages (from-to)322-328
Number of pages7
JournalEuropean Journal of Cardio-thoracic Surgery
Volume48
Issue number2
DOIs
StatePublished - Aug 1 2015
Externally publishedYes

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Keywords

  • Acute myocardial infarction
  • Mechanical circulatory support

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Truby, L., Naka, Y., Kalesan, B., Ota, T., Kirtane, A. J., Kodali, S., Nikic, N., Mundy, L., Colombo, P., Jorde, U. P., & Takayama, H. (2015). Important role of mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock. European Journal of Cardio-thoracic Surgery, 48(2), 322-328. [ezu478]. https://doi.org/10.1093/ejcts/ezu478