Comparison of In-Hospital Outcomes in Acute Myocardial Infarction-Cardiogenic Shock (AMICS) versus Non-AMICS Following ECPELLA

PurposeCardiogenic shock (CS) in patients with acute myocardial infarction (AMI) differs significantly in its clinical course compared to non-AMICS patients. Data on differences in outcomes on use of mechanical circulatory support devices like VA-ECMO plus Impella (ECPELLA) in these 2 different CS phenotypes is lacking. We aim to discern in-hospital outcomes following ECPELLA use based on type of CS.MethodsNational inpatient sample database from years 2015-20 was queried to select patients admitted with CS. Patients were included if they received VA-ECMO with Impella during admission. Primary outcomes included in-hospital mortality and progression to index LVAD implantation/ heart transplant. Secondary outcomes included major bleeding, vascular, and thromboembolic complications, acute kidney injury (AKI) requiring hemodialysis (HD), and length of stay.ResultsA total of 1500 (AMICS= 800; Non-AMICS=700) patients were included in the final analysis. Patients with non-AMICS were younger with more comorbidities. On univariate analysis of AMICS versus non-AMICS patients, there was no significant difference in rates of in-hospital mortality which remained statistically insignificant on multivariate analysis (OR: 0.78 (0.38-1.61, p=0.51). Non-AMICS had significantly higher rates of progression to index LVAD implantation (13.5% vs. 5%, p= 0.01) or heart transplantation (9.29% vs.0.62%, p= 0.01). Similarly, Non-AMICS patients had higher rates of thromboembolic phenomenon (24.2% vs. 13.1%, p= 0.01), AKI requiring HD (10.5% vs. 7.7, p=0.01), and prolonged length of stay (27.27 ± 2.37 vs. 13.86 ± 1.50 days; p=0.001). There were no significant differences in major bleeding or vascular complications.ConclusionIn-hospital mortality did not differ in CS patients requiring ECPELLA despite significantly higher rates of complications in non-AMICS group. Index LVAD implantation or heart transplantation was significantly higher in patients with non-AMICS. Cardiogenic shock (CS) in patients with acute myocardial infarction (AMI) differs significantly in its clinical course compared to non-AMICS patients. Data on differences in outcomes on use of mechanical circulatory support devices like VA-ECMO plus Impella (ECPELLA) in these 2 different CS phenotypes is lacking. We aim to discern in-hospital outcomes following ECPELLA use based on type of CS. National inpatient sample database from years 2015-20 was queried to select patients admitted with CS. Patients were included if they received VA-ECMO with Impella during admission. Primary outcomes included in-hospital mortality and progression to index LVAD implantation/ heart transplant. Secondary outcomes included major bleeding, vascular, and thromboembolic complications, acute kidney injury (AKI) requiring hemodialysis (HD), and length of stay. A total of 1500 (AMICS= 800; Non-AMICS=700) patients were included in the final analysis. Patients with non-AMICS were younger with more comorbidities. On univariate analysis of AMICS versus non-AMICS patients, there was no significant difference in rates of in-hospital mortality which remained statistically insignificant on multivariate analysis (OR: 0.78 (0.38-1.61, p=0.51). Non-AMICS had significantly higher rates of progression to index LVAD implantation (13.5% vs. 5%, p= 0.01) or heart transplantation (9.29% vs.0.62%, p= 0.01). Similarly, Non-AMICS patients had higher rates of thromboembolic phenomenon (24.2% vs. 13.1%, p= 0.01), AKI requiring HD (10.5% vs. 7.7, p=0.01), and prolonged length of stay (27.27 ± 2.37 vs. 13.86 ± 1.50 days; p=0.001). There were no significant differences in major bleeding or vascular complications. In-hospital mortality did not differ in CS patients requiring ECPELLA despite significantly higher rates of complications in non-AMICS group. Index LVAD implantation or heart transplantation was significantly higher in patients with non-AMICS.