Trends and Outcomes of Mechanical Circulatory Support in Acute Myocardial Infarction 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. Preoperative, intraoperative, and postoperative 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: During the study period, 34,015 patients with AMI-CS underwent CABG. The annualized volume ranged from 2964 in 2011 to 2646 in 2022, and operative mortality decreased from 24.2% in 2011 to 19.0% in 2022 (P for trend <.001). Preoperatively, IABP was used in 23,833 patients (70.1%), tMCS in 2173 patients (6.4%), ECMO in 173 patients (0.5%), and multiple devices in 499 (1.5%). Preoperative IABP use decreased from 2210 (74.6%) in 2011 to 1710 (64.6%) in 2022, and preoperative tMCS use increased from 38 (1.3%) in 2011 to 298 (11.3%) in 2022. Preoperative ECMO (P for trend = .004) or multiple device use (P for trend <.001) remained rare but increased over time. Preoperative IABP use was associated with lower operative mortality (18.0% vs 24.4%; adjusted odds ratio, 0.76; 95% CI, 0.71-0.82; P < .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.
