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Open AccessArticle

Prognostic Impact of Active Mechanical Circulatory Support in Cardiogenic Shock Complicating Acute Myocardial Infarction, Results from the Culprit-Shock Trial

1
Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, 04289 Leipzig, Germany
2
Institut für Herzinfarktforschung GmbH, IHF, 67063 Ludwigshafen, Germany
3
Klinik für Innere Medizin/Kardiologie, Klinikum 67063 Ludwigshafen, Germany
4
Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University Hospital Schleswig-Holstein, 23538 Lübeck, Germany
5
University Medical Center Ljubljana, 1000 Ljubljana, Slovenia
6
Institute of Cardiology, 04-628 Warsaw, Poland
7
Department of Cardiology, Wilhelminenspital and Sigmund Freud University, Medical School, 1160 Vienna, Austria
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(6), 1976; https://doi.org/10.3390/jcm9061976
Received: 25 May 2020 / Revised: 11 June 2020 / Accepted: 18 June 2020 / Published: 24 June 2020
(This article belongs to the Special Issue Diagnosis and Treatment of Myocardial Infarction)
Objectives: To analyze the use and prognostic impact of active mechanical circulatory support (MCS) devices in a large prospective contemporary cohort of patients with cardiogenic shock (CS) complicating acute myocardial infarction (AMI). Background: Although increasingly used in clinical practice, data on the efficacy and safety of active MCS devices in patients with CS complicating AMI are limited. Methods: This is a predefined subanalysis of the CULPRIT-SHOCK randomized trial and prospective registry. Patients with CS, AMI and multivessel coronary artery disease were categorized in two groups: (1) use of at least one active MCS device vs. (2) no active MCS or use of intra-aortic balloon pump (IABP) only. The primary endpoint was a composite of all-cause death or renal replacement therapy at 30 days. Results: Two hundred of 1055 (19%) patients received at least one active MCS device (n = 112 Impella®; n = 95 extracorporeal membrane oxygenation (ECMO); n = 6 other devices). The primary endpoint occurred significantly more often in patients treated with active MCS devices compared with those without active MCS devices (142 of 197, 72% vs. 374 of 827, 45%; p < 0.001). All-cause mortality and bleeding rates were significantly higher in the active MCS group (all p < 0.001). After multivariable adjustment, the use of active MCS was significantly associated with the primary endpoint (odds ratio (OR) 4.0, 95% confidence interval (CI) 2.7–5.9; p < 0.001). Conclusions: In the CULPRIT-SHOCK trial, active MCS devices were used in approximately one fifth of patients. Patients treated with active MCS devices showed worse outcome at 30 days and 1 year. View Full-Text
Keywords: cardiogenic shock; acute myocardial infarction; mechanical circulatory support; prognosis cardiogenic shock; acute myocardial infarction; mechanical circulatory support; prognosis
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Feistritzer, H.-J.; Desch, S.; Freund, A.; Poess, J.; Zeymer, U.; Ouarrak, T.; Schneider, S.; de Waha-Thiele, S.; Fuernau, G.; Eitel, I.; Noc, M.; Stepinska, J.; Huber, K.; Thiele, H. Prognostic Impact of Active Mechanical Circulatory Support in Cardiogenic Shock Complicating Acute Myocardial Infarction, Results from the Culprit-Shock Trial. J. Clin. Med. 2020, 9, 1976.

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