Outcomes of Mechanical Circulatory Support in STEMI Patients with Cardiogenic Shock: Insights from the National Inpatient Sample

Abstract

Background Cardiogenic shock has been associated with a high mortality rate despite advances in mechanical circulatory support. Data is inconsistent as the majority of patients in the current trials are SCAI stage E, or data is combined with heart failure and STEMI cardiogenic shock. Methods Data was extracted from the 2020 United States National Inpatient data set. The diagnosis criteria were “STEMI” and “Cardiogenic shock”. The primary outcome of interest was comparing mortality in those patients who received mechanical circulatory support vs. those who did not in STEMI Cardiogenic shock. Results There were 4,302 patients with STEMI and cardiogenic shock, and 65.3% were males. The mean age was 66.7 years (SD 12.3), and the mean length of hospital stay was 7.9 days (SD 10.03). 36% of the patients died during hospital admission. 29% received an intra-aortic balloon pump (IABP), 15.5% had Impella left ventricular support, 3.2% had veno-arterial extracorporeal membrane oxygenation (ECMO), 2.2% had both IABP and Impella, 1.3% had both Impella and ECMO and 1.0% had both IABP and ECMO. The Kaplan-Meier analysis showed that IABP use was associated with decreased in-hospital mortality (p\u3c0.001). In the multivariate analysis, age (OR 1.034, 95% CI 1.028-1.04, p\u3c0.001), female (OR 1.26, 95% CI 1.1-1.45, p\u3c0.001), acute kidney injury (OR 1.96, 95% CI 1.71-2.25, p\u3c0.001), ECMO (OR 1.74, 95% CI 1.22-2.50, p=0.003), and Impella (OR 1.72, 95% CI 1.45-2.06, p\u3c0.001) were associated with increased in-hospital mortality. Conversely, using IABP (OR 0.65, 95% CI 0.56-0.76, p\u3c0.001) was associated with decreased in-hospital mortality. Conclusions Mechanical circulatory support devices are used individually and in combination with each other in patients with cardiogenic shock, with IABP being the most commonly used. However, in-hospital mortality remains high, but using IABP was associated with decreased in-hospital mortality. The patients with IABP were more likely SCAI stage C rather than SCAI stage E; therefore, this could have contributed to the decrease in-hospital mortality