Characteristics and Outcomes of Early vs Late Initiation of Mechanical Circulatory Support in Non-Acute Myocardial Infarction related Cardiogenic Shock: An Analysis of the National Inpatient Sample Database

Cardiogenic shock (CS) is significant cause of mortality. The use of mechanical circulatory support (MCS) in patients with non-acute myocardial infarction (Non-AMI) CS is lacking. We inquired data regarding the trends and outcomes early vs late initiation of MCS in non-AMI CS. We investigated Nation...

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Bibliographic Details
Published in:	Current problems in cardiology Vol. 48; no. 5; p. 101584
Main Authors:	Barssoum, Kirolos, Patel, Harsh P., Abdelmaseih, Ramy, Hassib, Mohab, Victor, Varun, Mohamed, Ahmed, Jazar, Deaa Abu, Mai, Steven, Ibrahim, Fadi, Patel, Bhavin, Baeni, Aiham el, Khalife, Wissam, Bandyopadhay, Dhrubjyoti, Rai, Devesh, Chatila, Khaled
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-05-2023
Subjects:	Heart-Assist Devices - adverse effects Humans Inpatients Intra-Aortic Balloon Pumping - adverse effects Myocardial Infarction - complications Myocardial Infarction - epidemiology Myocardial Infarction - therapy Shock, Cardiogenic - epidemiology Shock, Cardiogenic - etiology Shock, Cardiogenic - therapy Treatment Outcome
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Summary:	Cardiogenic shock (CS) is significant cause of mortality. The use of mechanical circulatory support (MCS) in patients with non-acute myocardial infarction (Non-AMI) CS is lacking. We inquired data regarding the trends and outcomes early vs late initiation of MCS in non-AMI CS. We investigated National Inpatient Sample database between October 2015-December 2018, identifying hospitalizations with CS, either complicated by AMI or Non-AMI. Patients were divided into 2 cohorts, early initiation of MCS (<48 hours) and late initiation of MCS (>48 hours). The primary analysis included death within first 24 hours. A secondary analysis was adjusted after excluding patients who died in first 24 hours. A total of 85,318 patients with non-AMI-related CS with MCS placement were identified. Among this cohort, 54.6% (n=46,579) underwent early initiation of MCS within 48 hours, and 45.4% (n=38,739) underwent late initiation of MCS after 48 hours. In primary analysis, early MCS initiation was associated with more in-hospital mortality in primary outcome of all-cause hospital mortality (35.72% vs 27.63%, P<0.0001, OR 1.44, 95% CI: 1.40-1.49, P<0.0001), however, adjusted secondary analysis showed a statistically significant decrease in all-cause hospital mortality (23.63% vs 27.63%, P<0.0001, OR 0.80, 95% CI: 0.78-0.83, P<0.0001). In non-AMI-related CS and based on survival to 24 hours after admission, early initiation of MCS had statistically significant decrease in all-cause hospital mortality, with less incidence of vascular and renal complications, and shorter hospital stay. Late initiation of MCS was associated with a higher incidence of advanced therapies, including LVAD and transplant.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Review-1
ISSN:	0146-2806 1535-6280
DOI:	10.1016/j.cpcardiol.2023.101584