Complications and Outcomes in 39,864 Patients Receiving Standard Care Plus Mechanical Circulatory Support or Standard Care Alone for Infarct-Associated Cardiogenic Shock
Background: Temporary mechanical circulatory support devices (tMCS) are increasingly being used in patients with infarct-associated cardiogenic shock (AMICS). Evidence on patient selection, complications and long-term outcomes is lacking. We aim to investigate differences in clinical characteristics...
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| Format: | Article |
| Language: | English |
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MDPI AG
2024-02-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/13/4/1167 |
| _version_ | 1797297820265349120 |
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| author | Jan-Sören Padberg Jannik Feld Leonie Padberg Jeanette Köppe Lena Makowski Joachim Gerß Patrik Dröge Thomas Ruhnke Christian Günster Stefan Andreas Lange Holger Reinecke |
| author_facet | Jan-Sören Padberg Jannik Feld Leonie Padberg Jeanette Köppe Lena Makowski Joachim Gerß Patrik Dröge Thomas Ruhnke Christian Günster Stefan Andreas Lange Holger Reinecke |
| author_sort | Jan-Sören Padberg |
| collection | DOAJ |
| description | Background: Temporary mechanical circulatory support devices (tMCS) are increasingly being used in patients with infarct-associated cardiogenic shock (AMICS). Evidence on patient selection, complications and long-term outcomes is lacking. We aim to investigate differences in clinical characteristics, complications and outcomes between patients receiving no tMCS or either intra-aortic balloon pump (IABP), veno-arterial extracorporeal membrane oxygenation (V-A ECMO) or Impella<sup>®</sup> for AMICS, with a particular focus on long-term outcomes. Methods: Using health claim data from AOK—Die Gesundheitskasse (local health care funds), we retrospectively analysed complications and outcomes of all insured patients with AMICS between 1 January 2010 and 31 December 2017. Results: A total of 39,864 patients were included (IABP 5451; Impella 776; V-A ECMO 833; no tMCS 32,804). In-hospital complications, including renal failure requiring dialysis (50.3% V-A ECMO vs. 30.5% Impella vs. 29.2 IABP vs. 12.1% no tMCS), major bleeding (38.1% vs. 20.9% vs. 18.0% vs. 9.3%) and sepsis (22.5% vs. 15.9% vs. 13.9% vs. 9.3%) were more common in V-A ECMO patients. In a multivariate analysis, the use of both V-A ECMO (HR 1.57, <i>p</i> < 0.001) and Impella (HR 1.25, <i>p</i> < 0.001) were independently associated with long-term mortality, whereas use of IABP was not (HR 0.89, <i>p</i> < 0.001). Kaplan–Meier estimates showed better survival for patients on IABP compared with Impella, V-A ECMO and no-tMCS. Short- and long-term mortality was high across all groups. Conclusions: Our data show noticeably more in-hospital complications in patients on tMCS and higher mortality with V-A ECMO and Impella. The use of both devices is an independent risk factor for mortality, whereas the use of IABP is associated with a survival benefit. |
| first_indexed | 2024-03-07T22:26:51Z |
| format | Article |
| id | doaj.art-9b21b290bc0a48a7a9c4601d77f43211 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-07T22:26:51Z |
| publishDate | 2024-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-9b21b290bc0a48a7a9c4601d77f432112024-02-23T15:22:29ZengMDPI AGJournal of Clinical Medicine2077-03832024-02-01134116710.3390/jcm13041167Complications and Outcomes in 39,864 Patients Receiving Standard Care Plus Mechanical Circulatory Support or Standard Care Alone for Infarct-Associated Cardiogenic ShockJan-Sören Padberg0Jannik Feld1Leonie Padberg2Jeanette Köppe3Lena Makowski4Joachim Gerß5Patrik Dröge6Thomas Ruhnke7Christian Günster8Stefan Andreas Lange9Holger Reinecke10Department for Cardiology I: Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Münster, Albert-Schweitzer-Campus 1, D-48149 Münster, GermanyInstitute of Biostatistics and Clinical Research, University of Münster, D-48149 Münster, GermanyDepartment for Cardiology I: Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Münster, Albert-Schweitzer-Campus 1, D-48149 Münster, GermanyInstitute of Biostatistics and Clinical Research, University of Münster, D-48149 Münster, GermanyDepartment for Cardiology I: Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Münster, Albert-Schweitzer-Campus 1, D-48149 Münster, GermanyInstitute of Biostatistics and Clinical Research, University of Münster, D-48149 Münster, GermanyAOK Research Institute (WIdO), AOK-Bundesverband, D-10178 Berlin, GermanyAOK Research Institute (WIdO), AOK-Bundesverband, D-10178 Berlin, GermanyAOK Research Institute (WIdO), AOK-Bundesverband, D-10178 Berlin, GermanyDepartment for Cardiology I: Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Münster, Albert-Schweitzer-Campus 1, D-48149 Münster, GermanyDepartment for Cardiology I: Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Münster, Albert-Schweitzer-Campus 1, D-48149 Münster, GermanyBackground: Temporary mechanical circulatory support devices (tMCS) are increasingly being used in patients with infarct-associated cardiogenic shock (AMICS). Evidence on patient selection, complications and long-term outcomes is lacking. We aim to investigate differences in clinical characteristics, complications and outcomes between patients receiving no tMCS or either intra-aortic balloon pump (IABP), veno-arterial extracorporeal membrane oxygenation (V-A ECMO) or Impella<sup>®</sup> for AMICS, with a particular focus on long-term outcomes. Methods: Using health claim data from AOK—Die Gesundheitskasse (local health care funds), we retrospectively analysed complications and outcomes of all insured patients with AMICS between 1 January 2010 and 31 December 2017. Results: A total of 39,864 patients were included (IABP 5451; Impella 776; V-A ECMO 833; no tMCS 32,804). In-hospital complications, including renal failure requiring dialysis (50.3% V-A ECMO vs. 30.5% Impella vs. 29.2 IABP vs. 12.1% no tMCS), major bleeding (38.1% vs. 20.9% vs. 18.0% vs. 9.3%) and sepsis (22.5% vs. 15.9% vs. 13.9% vs. 9.3%) were more common in V-A ECMO patients. In a multivariate analysis, the use of both V-A ECMO (HR 1.57, <i>p</i> < 0.001) and Impella (HR 1.25, <i>p</i> < 0.001) were independently associated with long-term mortality, whereas use of IABP was not (HR 0.89, <i>p</i> < 0.001). Kaplan–Meier estimates showed better survival for patients on IABP compared with Impella, V-A ECMO and no-tMCS. Short- and long-term mortality was high across all groups. Conclusions: Our data show noticeably more in-hospital complications in patients on tMCS and higher mortality with V-A ECMO and Impella. The use of both devices is an independent risk factor for mortality, whereas the use of IABP is associated with a survival benefit.https://www.mdpi.com/2077-0383/13/4/1167ImpellaV-A ECMOIABPcardiogenic shockacute myocardial infarctionmechanical circulatory support |
| spellingShingle | Jan-Sören Padberg Jannik Feld Leonie Padberg Jeanette Köppe Lena Makowski Joachim Gerß Patrik Dröge Thomas Ruhnke Christian Günster Stefan Andreas Lange Holger Reinecke Complications and Outcomes in 39,864 Patients Receiving Standard Care Plus Mechanical Circulatory Support or Standard Care Alone for Infarct-Associated Cardiogenic Shock Journal of Clinical Medicine Impella V-A ECMO IABP cardiogenic shock acute myocardial infarction mechanical circulatory support |
| title | Complications and Outcomes in 39,864 Patients Receiving Standard Care Plus Mechanical Circulatory Support or Standard Care Alone for Infarct-Associated Cardiogenic Shock |
| title_full | Complications and Outcomes in 39,864 Patients Receiving Standard Care Plus Mechanical Circulatory Support or Standard Care Alone for Infarct-Associated Cardiogenic Shock |
| title_fullStr | Complications and Outcomes in 39,864 Patients Receiving Standard Care Plus Mechanical Circulatory Support or Standard Care Alone for Infarct-Associated Cardiogenic Shock |
| title_full_unstemmed | Complications and Outcomes in 39,864 Patients Receiving Standard Care Plus Mechanical Circulatory Support or Standard Care Alone for Infarct-Associated Cardiogenic Shock |
| title_short | Complications and Outcomes in 39,864 Patients Receiving Standard Care Plus Mechanical Circulatory Support or Standard Care Alone for Infarct-Associated Cardiogenic Shock |
| title_sort | complications and outcomes in 39 864 patients receiving standard care plus mechanical circulatory support or standard care alone for infarct associated cardiogenic shock |
| topic | Impella V-A ECMO IABP cardiogenic shock acute myocardial infarction mechanical circulatory support |
| url | https://www.mdpi.com/2077-0383/13/4/1167 |
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