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Updated: Jan 13, 2026
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Prognostic Factors Among Patients Receiving Microaxial Flow Pump for Acute Myocardial Infarction-Related Cardiogenic
Simon Parlow1,2,3, Richard G Jung1,4,5, Sayed Abdulmotaleb Almoosawy4
1CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, ON, Canada.
Objectives:
To identify factors associated with short-term mortality among patients receiving microaxial flow pump (mAFP) therapy for acute myocardial infarction-related cardiogenic shock (AMI-CS).
Data Sources:
We searched four databases (MEDLINE, Embase, CENTRAL, and Scopus) from January 1, 2004, to January 1, 2025.
Study Selection:
We selected English-language studies that included adults with AMI-CS receiving mAFP and evaluated factors associated with short-term mortality. We excluded patients receiving concurrent venoarterial extracorporeal membrane oxygenation, as well as studies that solely included patients presenting with out-of-hospital cardiac arrest.
Data Extraction:
Two authors performed citation screening and data extraction. For each factor evaluated in at least two studies, we performed meta-analyses of adjusted odds ratios (aORs) using a random-effects model. Risk of bias was evaluated using the Quality in Prognosis Studies tool, and the certainty of evidence was evaluated using Grading of Recommendations, Assessment, Development, and Evaluations methodology.
Data Synthesis:
Our primary analysis included 18 studies, encompassing 20,617 patients. Median short-term mortality across studies was 50.7% (interquartile range 38.4-55.3%). Factors associated with short-term mortality based on high-certainty evidence included: increased age (aOR, 1.04 per year [95% CI, 1.03-1.05 per year] or ≥ 65 yr (aOR, 2.42 yr [95% CI, 0.77-7.64 yr]), female sex (aOR, 1.26 [95% CI, 1.09-1.45]), higher body mass index (aOR, 1.05 per point [95% CI, 1.04-1.07 per point]), higher heart rate (aOR, 1.02 per beats/min [95% CI, 1.01-1.02 per beats/min]), higher serum creatinine (aOR, 1.35 per mg/dL [95% CI, 1.08-1.70 per mg/dL]), mechanical ventilation (aOR, 2.53 [95% CI, 1.82-3.53]), vasopressors (aOR, 1.52 [95% CI, 1.11-2.08] for any vasopressors and aOR, 1.37 [95% CI, 1.18-1.58] per each vasopressor), presentation with ST-elevation myocardial infarction (aOR, 1.59 [95% CI, 1.11-2.26]), cardiac arrest (aOR, 2.85 [95% CI, 2.22-3.64]), and hypoxic-ischemic brain injury (aOR, 5.36 [95% CI, 3.03-9.47]).
Conclusions:
We identified several prognostic factors associated with short-term mortality in AMI-CS patients receiving mAFP support. This work may help inform clinicians, patients, and families regarding utilization of mAFP in AMI-CS.
Insights
This study identified key factors predicting short-term mortality in patients with acute myocardial infarction-related cardiogenic shock (AMI-CS) treated with microaxial flow pump (mAFP) therapy. Understanding these prognostic indicators can aid clinical decision-making and patient counseling.
Area of Science:
- Cardiology
- Critical Care Medicine
- Medical Devices
Background:
- Acute myocardial infarction-related cardiogenic shock (AMI-CS) is a severe complication with high mortality.
- Microaxial flow pump (mAFP) therapy is utilized for AMI-CS, but prognostic factors for short-term outcomes require further elucidation.
Purpose of the Study:
- To identify and analyze factors associated with short-term mortality in patients with AMI-CS undergoing mAFP therapy.
- To provide evidence-based insights for clinicians managing these high-risk patients.
Main Methods:
- A systematic literature search was conducted across four major databases (MEDLINE, Embase, CENTRAL, Scopus) from 2004 to 2025.
- Included were English-language studies of adult AMI-CS patients receiving mAFP, excluding those on concurrent ECMO or with out-of-hospital cardiac arrest.
- Meta-analyses of adjusted odds ratios were performed for factors identified in at least two studies, with risk of bias and certainty of evidence assessed.
Main Results:
- The analysis included 18 studies with 20,617 patients, showing a median short-term mortality of 50.7%.
- High-certainty evidence linked increased age, female sex, higher BMI, elevated heart rate, higher serum creatinine, mechanical ventilation, vasopressor use, ST-elevation myocardial infarction, cardiac arrest, and hypoxic-ischemic brain injury to increased short-term mortality.
- Specific adjusted odds ratios were reported for each identified factor.
Conclusions:
- Several prognostic factors significantly influence short-term mortality in AMI-CS patients treated with mAFP.
- These findings can inform clinical practice, patient selection, and family discussions regarding mAFP therapy in AMI-CS.
