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Updated: Jul 9, 2025
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Early Utilization of Mechanical Circulatory Support in Acute Myocardial Infarction Complicated by Cardiogenic Shock:
Mir B Basir1, Alejandro Lemor2, Sarah Gorgis1
1Henry Ford Hospital Detroit MI.
Insights
Early mechanical circulatory support (MCS) in acute myocardial infarction with cardiogenic shock (AMI-CS) is feasible and improves hemodynamics. This approach shows promising survival rates, warranting further investigation in randomized trials.
Area of Science:
- Cardiology
- Cardiovascular Interventions
- Critical Care Medicine
Background:
- Acute myocardial infarction with cardiogenic shock (AMI-CS) presents significant mortality risks.
- Mechanical circulatory support (MCS) devices are crucial for enhancing blood pressure and organ perfusion while decreasing cardiac filling pressures in AMI-CS patients.
Purpose of the Study:
- To evaluate the feasibility and effectiveness of early MCS implementation using Impella in patients diagnosed with AMI-CS.
- To assess the impact of early MCS on hemodynamic parameters and patient survival.
Main Methods:
- A single-arm, multicenter study (National Cardiogenic Shock Initiative, NCT03677180) enrolled 406 patients between 2016 and 2020.
- Data collected included patient demographics, presenting hemodynamic status (blood pressure, lactate, cardiac power output), and in-hospital interventions.
- The primary endpoint was in-hospital mortality, with secondary endpoints including survival rates at 30 days and 1 year.
Main Results:
- Patients presenting with AMI-CS showed improved systolic blood pressure (77.2 to 103.9 mm Hg) and reduced lactate levels (4.8 to 2.7 mmol/L) within 24 hours of MCS initiation.
- Cardiac power output significantly increased from 0.67 to 1.0 watts.
- Procedural survival was 99%, with survival to discharge at 71%, 30-day survival at 68%, and 1-year survival at 53%.
Conclusions:
- Early utilization of MCS in AMI-CS is feasible across diverse healthcare settings.
- The study demonstrated significant improvements in early hemodynamics and perfusion with high survival rates to hospital discharge.
- Randomized clinical trials are recommended to further validate the role of early MCS in AMI-CS management using a standardized, multidisciplinary approach.
Background:
Acute myocardial infarction complicated by cardiogenic shock (AMI-CS) is associated with significant morbidity and mortality. Mechanical circulatory support (MCS) devices increase systemic blood pressure and end organ perfusion while reducing cardiac filling pressures.
Methods And Results:
The National Cardiogenic Shock Initiative (NCT03677180) is a single-arm, multicenter study. The purpose of this study was to assess the feasibility and effectiveness of utilizing early MCS with Impella in patients presenting with AMI-CS. The primary end point was in-hospital mortality. A total of 406 patients were enrolled at 80 sites between 2016 and 2020. Average age was 64±12 years, 24% were female, 17% had a witnessed out-of-hospital cardiac arrest, 27% had in-hospital cardiac arrest, and 9% were under active cardiopulmonary resuscitation during MCS implantation. Patients presented with a mean systolic blood pressure of 77.2±19.2 mm Hg, 85% of patients were on vasopressors or inotropes, mean lactate was 4.8±3.9 mmol/L and cardiac power output was 0.67±0.29 watts. At 24 hours, mean systolic blood pressure improved to 103.9±17.8 mm Hg, lactate to 2.7±2.8 mmol/L, and cardiac power output to 1.0±1.3 watts. Procedural survival, survival to discharge, survival to 30 days, and survival to 1 year were 99%, 71%, 68%, and 53%, respectively.
Conclusions:
Early use of MCS in AMI-CS is feasible across varying health care settings and resulted in improvements to early hemodynamics and perfusion. Survival rates to hospital discharge were high. Given the encouraging results from our analysis, randomized clinical trials are warranted to assess the role of utilizing early MCS, using a standardized, multidisciplinary approach.
