Key result
Late mechanical circulatory support linked to ~39% higher acute ischemic stroke risk in AMI-CS.
Why the study?
Does early initiation of mechanical circulatory support reduce the risk of acute ischemic stroke in hospitalizations with acute myocardial infarction complicated by cardiogenic shock compared to late initiation?
Cohort (n=78,405)
Yes
Does early initiation of mechanical circulatory support reduce the risk of acute ischemic stroke in hospitalizations with acute myocardial infarction complicated by cardiogenic shock compared to late initiation?
Effect estimate: aOR 1.39 (95% CI 1.08-1.78)
Absolute Event Rate: 5.7% vs 4.14%
p-value: p=0.010
In patients with AMI complicated by cardiogenic shock, early initiation of mechanical circulatory support (<48 hours) is associated with a lower risk of acute ischemic stroke, acute kidney injury, and major bleeding compared to late initiation.
Should not yet alter MCS timing in AMI-CS; leaves open whether early initiation reduces AIS in randomized trials.
BACKGROUND: Mechanical circulatory support (MCS) devices have been widely used for managing acute myocardial infarction complicated by cardiogenic shock (AMI-CS). However, their use additionally elevates acute ischemic stroke (AIS) risk. There is insufficient data on the risk of AIS associated with early versus late initiation of MCS in AMI-CS cases. Therefore, this study aimed to assess the timing of MCS initiation associated with the risk of AIS in hospitalizations with AMI-CS. METHODS: A retrospective data analysis of the National Inpatient Sample (January 2016-December 2020) identified AMI-CS hospitalizations: categorized into early MCS initiation (< 48 h) and late MCS initiation (> 48 h). The primary outcome was AIS; the secondary outcomes included in-hospital mortality, acute kidney injury (AKI), cardiac arrest, major bleeding, and blood transfusion. The outcomes were compared using logistic multivariate regression and 1:1 propensity score matching analyses between the groups. RESULTS: Among 78,405 weighted hospitalizations with AMI-CS receiving MCS, 82.77% (n = 64,895) and 17.23% (n = 13,510) underwent early and late MCS initiation, respectively. Hospitalizations with late MCS initiation had higher risks of AIS (adjusted odds ratio [aOR], 1.46; 95%confidence interval [CI], 1.19-1.79; p < 0.001), AKI (aOR, 1.41; 95%CI, 1.27-1.55; p < 0.001), and major bleeding (aOR, 1.12; 95%CI, 1.01-1.23; p = 0.028). After propensity score matching, late MCS initiation remained associated with increased risks of AIS (aOR, 1.39; 95%CI, 1.08-1.78; p = 0.010), AKI (aOR, 1.37; 95%CI, 1.23-1.53; p < 0.001), and major bleeding (aOR, 1.14; 95%CI, 1.02-1.28; p = 0.027). CONCLUSIONS: Late initiation of MCS was associated with increased risks of AIS, AKI, and major bleeding.
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Yan et al. (2025) conducted a cohort in Acute myocardial infarction complicated by cardiogenic shock (n=78,405). Late initiation of mechanical circulatory support (> 48 h) vs. Early initiation of mechanical circulatory support (< 48 h) was evaluated on Acute ischemic stroke during hospitalization (aOR 1.39, 95% CI 1.08-1.78, p=0.010). Late initiation of mechanical circulatory support (>48 hours) increased the risk of acute ischemic stroke (aOR 1.39) compared to early initiation in patients with AMI complicated by cardiogenic shock.
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