Predictors of Mortality in Acute Myocardial Infarction Complicated by Cardiogenic Shock despite Intra-Aortic Balloon Pump: Opportunities for Advanced Mechanical Circulatory Support in Asia

Author:

Lin Weiqin12ORCID,Yip Alfred Chung Lum1ORCID,Cherian Robin12ORCID,Chan Siew Pang23,Evangelista Lauren Kay Mance145,Sari Novi Yanti16,Ling Hwei Sung178,Lim Yoke Ching12,Wong Raymond Ching Chiew12,Tung Benjamin Wei Liang1ORCID,Tan Li-Ling12,Low Adrian F.12,Ambhore Anand Adinath12,Lim Shir Lynn12ORCID

Affiliation:

1. Department of Cardiology, National University Heart Centre, Singapore 119074, Singapore

2. Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore

3. Cardiovascular Research Institute, National University Heart Centre, Singapore 119074, Singapore

4. De La Salle Medical and Health Sciences Institute, Dasmarinas 4114, Philippines

5. Department of Cardiology, University of the Philippines—Philippine General Hospital, Manilla 1000, Philippines

6. Dr Mohammad Hoesin General Hospital Palembang, South Sumatra, Kota Palembang 30126, Indonesia

7. Department of Medicine, Faculty of Medicine and Health Science, Universiti Malaysia Sarawak, Kota Samarahan 94300, Malaysia

8. Department of Cardiology, Sarawak Heart Centre, Kota Samarahan 94300, Malaysia

Abstract

Introduction: Acute myocardial infarction complicated by cardiogenic shock (AMI-CS) mortality remains high despite revascularization and the use of the intra-aortic balloon pump (IABP). Advanced mechanical circulatory support (MCS) devices, such as catheter-based ventricular assist devices (cVAD), may impact mortality. We aim to identify predictors of mortality in AMI-CS implanted with IABP and the proportion eligible for advanced MCS in an Asian population. Methods: We retrospectively analyzed a cohort of Society for Cardiovascular Angiography and Intervention (SCAI) stage C and above AMI-CS patients with IABP implanted from 2017–2019. We excluded patients who had IABP implanted for indications other than AMI-CS. Primary outcome was 30-day mortality. Binary logistic regression was used to calculate adjusted odds ratios (aOR) for patient characteristics. Results: Over the 3-year period, 242 patients (mean age 64.1 ± 12.4 years, 88% males) with AMI-CS had IABP implanted. 30-day mortality was 55%. On univariate analysis, cardiac arrest (p < 0.001), inotrope/vasopressor use prior to IABP (p = 0.004) was more common in non-survivors. Non-survivors were less likely to be smokers (p = 0.001), had lower ejection fraction, higher creatinine/ lactate and lower pH (all p < 0.001). On multi-variate analysis, predictors of mortality were cardiac arrest prior to IABP (aOR 4.00, CI 2.28–7.03), inotrope/vasopressor prior to IABP (aOR 2.41, CI 1.18–4.96), lower arterial pH (aOR 0.02, CI 0.00–0.31), higher lactate (aOR 2.42, CI 1.00–1.19), and lower hemoglobin (aOR 0.83, CI 0.71–0.98). Using institutional MCS criteria, 106 patients (44%) would have qualified for advanced MCS. Conclusions: Early mortality in AMI-CS remains high despite IABP. Many patients would have qualified for higher degrees of MCS.

Publisher

MDPI AG

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