Trends in mechanical circulatory support utilization for spontaneous coronary artery dissection–related cardiogenic shock

Purpose Spontaneous coronary artery dissection (SCAD) is increasingly recognized as an important cause of acute coronary syndromes, and cardiogenic shock (SCAD-CS) remains a rare but devastating complication. Given the lack of guidelines for managing SCAD-CS, the purpose of this study was to examine how mechanical circulatory support (MCS) has been utilized in this setting and how practices evolved over time. Methods Using the National Inpatient Sample, we included female patients ≥18 years diagnosed with SCAD-CS from 2016 to 2020. Patients were classified by MCS use and device type: intra-aortic balloon pump (IABP), Impella, and extracorporeal membrane oxygenation (ECMO). Demographics, comorbidities, clinical characteristics, and mortality were analyzed using univariate tests and multivariable logistic regression. Results Among 503 patients with SCAD-CS, 322 (64%) received MCS. Of those, 200 had IABP, 125 had Impella, and 38 had ECMO; Escalation to ECMO was required in 12 patients initially supported with Impella and 6 patients supported with IABP. Median day of onset from admission was 0 for IABP, 1 for Impella, and 2 for ECMO. Overall, MCS utilization trends remained stable throughout the study period, with no statistically significant changes in the specific proportions of IABP ( p = 0.203), Impella ( p = 0.622), or ECMO ( p = 0.891) used. Atrial fibrillation was associated with increased MCS use (OR 1.63; 95% CI 1.01–2.61; p = 0.044). Mortality was 27.6% without MCS vs 29.8% with MCS ( p = 0.604). Older age (OR 1.04; p = 0.004) and anemia (OR 2.4; p = 0.041) predicted mortality. Conclusions While identified cases of SCAD-CS rose significantly from 2016 to 2020, overall MCS utilization remained statistically stable. Future multicenter efforts are needed to determine which specific management strategy and MCS modality and is most adequate for this unique patient population.