Prognosis in Patients With Cardiogenic Shock Who Received Temporary Mechanical Circulatory Support

Toru Kondo; Takashi Araki; Takahiro Imaizumi; Yoko Sumita; Michikazu Nakai; Akihito Tanaka; Takahiro Okumura; Jawad H Butt; Mark C Petrie; John J V McMurray; Toyoaki Murohara

doi:10.1016/j.jacasi.2022.10.004

Prognosis in Patients With Cardiogenic Shock Who Received Temporary Mechanical Circulatory Support

JACC Asia. 2022 Oct 31;3(1):122-134. doi: 10.1016/j.jacasi.2022.10.004. eCollection 2023 Feb.

Authors

Toru Kondo^{1

2}, Takashi Araki¹, Takahiro Imaizumi^{3

4}, Yoko Sumita⁵, Michikazu Nakai⁵, Akihito Tanaka¹, Takahiro Okumura¹, Jawad H Butt^{2

6}, Mark C Petrie², John J V McMurray², Toyoaki Murohara¹

Affiliations

¹ Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
² British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.
³ Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
⁴ Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan.
⁵ Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan.
⁶ Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.

Abstract

Background: Temporary mechanical circulatory support (MCS) is often used in patients with cardiogenic shock (CS), and the type of MCS may vary by cause of CS.

Objectives: This study sought to describe the causes of CS in patients receiving temporary MCS, the types of MCS used, and associated mortality.

Methods: This study used a nationwide Japanese database to identify patients receiving temporary MCS for CS between April 1, 2012, and March 31, 2020.

Results: Of 65,837 patients, the cause of CS was acute myocardial infarction (AMI) in 77.4%, heart failure (HF) in 10.9%, valvular disease in 2.7%, fulminant myocarditis (FM) in 2.5%, arrhythmia in 4.5%, and pulmonary embolism (PE) in 2.0% of cases. The most commonly used MCS was an intra-aortic balloon pump alone in AMI (79.2%) and in HF (79.0%) and in valvular disease (66.0%), extracorporeal membrane oxygenation with intra-aortic balloon pump in FM (56.2%) and arrhythmia (43.3%), and extracorporeal membrane oxygenation alone in PE (71.5%). Overall in-hospital mortality was 32.4%; 30.0% in AMI, 32.6% in HF, 33.1% in valvular disease, 34.2% in FM, 60.9% in arrhythmia, and 59.2% in PE. Overall in-hospital mortality increased from 30.4% in 2012 to 34.1% in 2019. After adjustment, valvular disease, FM, and PE had lower in-hospital mortality than AMI: valvular disease, OR: 0.56 (95% CI: 0.50-0.64); FM: OR: 0.58 (95% CI: 0.52-0.66); PE: OR: 0.49 (95% CI: 0.43-0.56); whereas HF had similar in-hospital mortality (OR: 0.99; 95% CI: 0.92-1.05) and arrhythmia had higher in-hospital mortality (OR: 1.14; 95% CI: 1.04-1.26).

Conclusions: In a Japanese national registry of patients with CS, different causes of CS were associated with different types of MCS and differences in survival.

Keywords: AMI, acute myocardial infarction; CS, cardiogenic shock; ECMO, extracorporeal membrane oxygenation; FM, fulminant myocarditis; HF, heart failure; IABP, intra-aortic balloon pump; ICD-10, International Classification of Diseases-10th Revision; MCS, mechanical circulatory support; OR, odds ratio; PE, pulmonary embolism; cardiogenic shock; extracorporeal membrane oxygenation; intra-aortic balloon pump; mechanical circulatory support; pVAD, percutaneous ventricular assist device; percutaneous ventricular assist device.