Important role of mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock.

Journal Article (Journal Article)

OBJECTIVES: Acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) remains associated with significant mortality despite the widespread application of early revascularization strategies. Recent evidence suggests that the use of intra-aortic balloon pump (IABP) counterpulsation does not improve mortality in this cohort of patients. We summarize our experience with mechanical circulatory support (MCS) therapy for AMI/CS. METHODS: This is a retrospective review of 61 patients who received MCS therapy for AMI/CS at our institution between March 2007 and March 2013. RESULTS: Mean age was 60.2 ± 10.3 years; mean ejection fraction was 24 ± 15% and 29% of patients were receiving active cardiopulmonary resuscitation at the time of support initiation. Prior to the initiation of MCS, 70.5% of patients had an IABP. Mean arterial pressure improved significantly with MCS (63 mmHg prior to MCS, 82 mmHg after MCS, P ≤ 0.01). Mean length of support was 9.5 ± 11.0 days, and overall survival to 30 days was 59.0%. Among 30-day survivors, 44.4% required device exchange to a durable MCS device. Ultimately, only 31% (52.8% of patients who survived to 30 days) achieved myocardial recovery. CONCLUSIONS: Short-term MCS therapy with subsequent aggressive use of durable MCS device may improve the unacceptably high mortality rate in AMI/CS. Rigorous prospective studies of MCS therapy in AMI/CS are warranted.

Full Text

Duke Authors

Cited Authors

  • Truby, L; Naka, Y; Kalesan, B; Ota, T; Kirtane, AJ; Kodali, S; Nikic, N; Mundy, L; Colombo, P; Jorde, UP; Takayama, H

Published Date

  • August 2015

Published In

Volume / Issue

  • 48 / 2

Start / End Page

  • 322 - 328

PubMed ID

  • 25480935

Electronic International Standard Serial Number (EISSN)

  • 1873-734X

Digital Object Identifier (DOI)

  • 10.1093/ejcts/ezu478


  • eng

Conference Location

  • Germany