Key result
In patients with stress-induced cardiomyopathy, use of Impella (aOR 1.98; 95% CI 1.12-3.49) or ECMO (aOR 4.15; 95% CI 1.85-9.32) was associated with higher in-hospital mortality than IABP.
Why the study?
The role of acute mechanical circulatory support in patients with stress-induced cardiomyopathy complicated by cardiogenic shock is not well studied.
Does Impella or ECMO improve in-hospital mortality compared to IABP in patients with stress-induced cardiomyopathy requiring acute mechanical circulatory support?
Observational (n=902)
Yes
Does Impella or ECMO improve in-hospital mortality compared to IABP in patients with stress-induced cardiomyopathy requiring acute mechanical circulatory support?
Odds Ratio: 1.98 (95% CI 1.12–3.49)
Absolute Event Rate: 29.1% vs 18.5%
In patients with stress-induced cardiomyopathy requiring mechanical support, use of Impella or ECMO was associated with higher in-hospital mortality and complications compared to IABP, though this may be driven by confounding by indication.
Should not yet change MCS practice in stress cardiomyopathy; leaves open whether Impella or ECMO increase mortality versus IABP due to confounding.
Background: The role of acute mechanical circulatory support (aMCS) in patients with stress-induced cardiomyopathy (SIC) complicated by cardiogenic shock (CS) is not well studied. Here, we describe the incidence and outcomes of aMCS use in SIC-CS using a large national database. Methods: Using the Nationwide Readmissions Database from January 2016 to November 2019, we identified patients hospitalized with SIC who received isolated intra-aortic balloon pump (IABP), microaxial flow pump (Impella, Abiomed), or extracorporeal membrane oxygenation (ECMO) during the index hospitalization. Results: A total of 902 among 94,709 hospitalizations for SIC (1.0%) required aMCS during the index hospitalization: 611 had IABP (67.7%), 189 had Impella (21.0%) and 102 had ECMO (11.3%). Patients with ECMO or Impella had higher in-hospital mortality rates than those with IABP (37.3% vs 29.1% vs 18.5%, respectively). There was an increased adjusted risk of in-hospital death with Impella (adjusted odds ratio [aOR], 1.98; 95% CI, 1.12-3.49) and ECMO (aOR, 4.15; 95% CI, 1.85-9.32) vs IABP. Impella was associated with an increased adjusted risk of 30-day readmission compared to IABP (aOR, 2.53; 95% CI, 1.16-5.51). Patients with ECMO or Impella had a higher incidence of renal replacement therapy and vascular/bleeding complications compared to those who received IABP. Conclusions: In this nationwide analysis using an administrative database, patients who received ECMO and Impella showed higher rates of in-hospital mortality, renal replacement therapy, and vascular/bleeding complications compared to those who received IABP. Patients with more comorbidities may receive more aggressive hemodynamic support which may account for observed mortality differences. Future prospective studies with objective and universal characterization of baseline clinical and hemodynamic characteristics of patients with CS secondary to SIC are needed.
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Jang et al. (2023) conducted an observational in Stress-induced cardiomyopathy complicated by cardiogenic shock (n=902). Impella or ECMO vs. IABP was evaluated on In-hospital mortality (aOR 1.98, 95% CI 1.12-3.49). In patients with stress-induced cardiomyopathy, use of Impella (aOR 1.98; 95% CI 1.12-3.49) or ECMO (aOR 4.15; 95% CI 1.85-9.32) was associated with higher in-hospital mortality than IABP.