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Cardiogenic shock is a life-threatening complication following delayed presentation of myocardial infarction (MI) and associated with high mortality rates. Percutaneous coronary intervention (PCI) with mechanical circulatory support (MCS) devices has emerged as a treatment strategy that rapidly restores perfusion while preserving hemodynamic stability. This study assesses outcomes after PCI with MCS devices in post-MI shock patients. The study included all patients who underwent PCI with percutaneous MCS devices. Outcomes were assessed 6 months post-procedure. Of the 131 patients, 65 (50%) were aged ≥75, 95 (73%) were male, and 87 (66%) were Caucasian. Impella was used in 112 (85%), ECMO alone in 5 (4%), and intra-aortic balloon pump (IABP) alone in 8 (6%). ECMO and Impella were used together in 5 (4%) patients, while IABP and Impella were used together in 2 (2%). Of the study population, 27 (21%) required blood transfusion Impella used vs. Impella not used: 21% (24/112) vs. 16% (3/19), p=0.72. The incidence of major adverse cardiovascular events (MACE), excluding death (MI, stroke, rehospitalization, and revascularization), was 37% (48/131) Impella used vs. Impella not used: 37% (41/112) vs. 37% (7/19), p=0.87. Cumulative mortality was 42% (55/131) Impella used vs. Impella not used: 42% (47/112) vs. 42% (8/19), p=0.84. The use of MCS devices in post-MI shock patients has similar rates of mortality and cardiovascular outcomes in patients not receiving support. Additional studies are required to determine which patients can benefit the most from these devices following post-MI CS.
Moumneh et al. (Wed,) studied this question.