Trends and Outcomes of Mechanical Circulatory Support in Acute MI and Cardiogenic Shock Patients Undergoing Coronary Artery Bypass Grafting.
Academic Article
Overview
abstract
BACKGROUND: We sought to describe trends and outcomes of mechanical circulatory support (MCS) use in acute myocardial infarction and cardiogenic shock (AMI-CS) patients undergoing coronary artery bypass grafting (CABG). METHODS: We identified all patients with AMI-CS undergoing CABG in the Society of Thoracic Surgeons Adult Cardiac Surgery Database from 2011 to 2022. Pre-, intra-, and post-operative use of intra-aortic balloon pump (IABP), catheter-based temporary MCS (tMCS), and extracorporeal membrane oxygenation (ECMO) were examined using multivariable regression and trends analyses. The primary outcome was operative mortality. RESULTS: In total, 34,015 patients with AMI-CS underwent CABG during the study period. The annualized volume ranged from 2,964 in 2011 to 2,646 in 2022, while operative mortality decreased from 24.2% in 2011 to 19.0% in 2022 (p for trend <0.001). Pre-operatively, IABP was used in 23,833 (70.1%) patients, tMCS in 2,173 (6.4%) patients, ECMO in 173 (0.5%) patients, and multiple devices in 499 (1.5%). Pre-operative IABP use decreased from 2,210 (74.6%) in 2011 to 1,710 (64.6%) in 2022, while pre-operative tMCS use increased from 38 (1.3%) in 2011 to 298 (11.3%) in 2022. Pre-operative ECMO (p for trend =0.004) or multiple device use (p for trend <0.001) remained rare but increased over time. Pre-operative IABP use was associated with lower operative mortality (18.0% vs 24.4%, aOR 0.76 [95% CI, 0.71-0.82], p<0.001). CONCLUSIONS: Operative mortality in AMI-CS patients undergoing CABG has decreased, while operative volumes have remained stable. IABP remains the most frequently used MCS, although its usage is declining in favor of tMCS.
