Open heart, Volume 12, Issue 1, 17 3 2025, Pages e002846 Clinical use and impact of mechanical circulatory support for myocardial infarction-related cardiogenic shock in the Netherlands: a registry-based propensity-matched analysis. Bogerd M, Griffioen AM, Bunge JJH, Peters EJ, Ten Berg S, Timmermans MJC, Kraaijeveld AO, Lipsic E, Otterspoor LC, Bleeker G, Montero-Cabezas JM, Sjauw KD, Meuwissen M, Dubois EA, van Geuns RM, Henriques JPS, PCI Registration Committee of the Netherlands Heart Registration
Background
Despite limited beneficial evidence, mechanical circulatory support (MCS) is commonly used in patients with acute myocardial infarction-related cardiogenic shock (AMI-CS). In this Dutch registry, we investigated MCS usage, associated patient characteristics and clinical outcomes.
Methods
This real-world, multicentre registry included CS patients undergoing percutaneous coronary intervention between 2017 and 2021 in 14 Dutch hospitals. The impact on clinical outcomes was analysed after 1:1 average propensity-score (aPS) matching.
Results
This AMI-CS registry included 2217 patients with a mean age of 66.4 (±12.3) years and predominantly male (72.8%, n=1613). MCS was deployed in 516 patients (23.3%), of which the intra-aortic balloon pump was used most frequently (n=253, 49.0%). Impella was used in 94 patients (18.2%), extracorporeal membrane oxygenation in 68 patients (13.2%) and 95 patients (18.4%) received multiple devices. Patients receiving MCS were younger (64.2 vs 67.0, p<0.01), presented with lower mean arterial pressures (74.7 vs 78.4 mm Hg, p<0.01), higher heart rates (88.3 vs 81.7 beats per minute, p<0.01) and higher initial lactate levels (6.4 vs 5.4 mmol/L, p<0.01). The percentage of resuscitated patients was comparable among MCS and non-MCS patients (38.6% vs 42.2%, p=0.17). The 30-day mortality rate was higher in MCS patients (55.0% vs 34.7%, p<0.01). After aPS-matching (n=970), 30-day mortality remained higher for MCS patients (53.8% vs 44.7%, p<0.01), with an associated OR of 1.44 (95% CI 1.12 to 1.85, p<0.01).
Conclusions
Despite limited evidence, MCS was used in a fourth of all AMI-CS patients. MCS usage was associated with an increased 30-day mortality in this real-world setting, even after propensity-matching.
