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Updated: Jul 12, 2026
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Trends in mechanical circulatory support utilization for spontaneous coronary artery dissection-related cardiogenic
Omar Khayat1, Chapman Wei1, Ahmad Mustafa1
1Northwell Health, New Hyde Park, NY, USA.
Insights
Mechanical circulatory support (MCS) use in spontaneous coronary artery dissection with cardiogenic shock (SCAD-CS) remained stable from 2016-2020. Older age and anemia predicted mortality in SCAD-CS patients receiving MCS.
Area of Science:
- Cardiology
- Interventional Cardiology
- Critical Care Medicine
Background:
- Spontaneous coronary artery dissection (SCAD) is an emerging cause of acute coronary syndromes.
- Cardiogenic shock (SCAD-CS) is a rare but severe complication of SCAD.
- Management guidelines for SCAD-CS are lacking, necessitating research into treatment strategies.
Purpose of the Study:
- To investigate the utilization patterns of mechanical circulatory support (MCS) in patients with SCAD-CS.
- To examine the evolution of MCS practices for SCAD-CS over time.
- To identify factors associated with MCS use and mortality in SCAD-CS.
Main Methods:
- Analysis of the National Inpatient Sample database for female patients diagnosed with SCAD-CS (2016-2020).
- Classification of patients based on MCS device: intra-aortic balloon pump (IABP), Impella, or extracorporeal membrane oxygenation (ECMO).
- Statistical analysis including univariate tests and multivariable logistic regression to assess demographics, comorbidities, clinical characteristics, and mortality.
Main Results:
- Of 503 SCAD-CS patients, 64% received MCS, with IABP (200), Impella (125), and ECMO (38) being the primary devices.
- MCS utilization trends remained stable across the study period; escalation to ECMO was noted in some Impella and IABP cases.
- Atrial fibrillation was linked to increased MCS use, while older age and anemia predicted higher mortality.
Conclusions:
- Despite a rise in SCAD-CS cases, overall MCS use remained statistically stable between 2016 and 2020.
- Mortality rates did not differ significantly between patients with and without MCS.
- Further multicenter research is required to establish optimal management strategies and MCS modalities for SCAD-CS.
Purpose:
Spontaneous coronary artery dissection (SCAD) is increasingly recognized as an important cause of acute coronary syndromes, and cardiogenic shock (SCAD-CS) remains a rare but devastating complication. Given the lack of guidelines for managing SCAD-CS, the purpose of this study was to examine how mechanical circulatory support (MCS) has been utilized in this setting and how practices evolved over time.
Methods:
Using the National Inpatient Sample, we included female patients ≥18 years diagnosed with SCAD-CS from 2016 to 2020. Patients were classified by MCS use and device type: intra-aortic balloon pump (IABP), Impella, and extracorporeal membrane oxygenation (ECMO). Demographics, comorbidities, clinical characteristics, and mortality were analyzed using univariate tests and multivariable logistic regression.
Results:
Among 503 patients with SCAD-CS, 322 (64%) received MCS. Of those, 200 had IABP, 125 had Impella, and 38 had ECMO; Escalation to ECMO was required in 12 patients initially supported with Impella and 6 patients supported with IABP. Median day of onset from admission was 0 for IABP, 1 for Impella, and 2 for ECMO. Overall, MCS utilization trends remained stable throughout the study period, with no statistically significant changes in the specific proportions of IABP (p = 0.203), Impella (p = 0.622), or ECMO (p = 0.891) used. Atrial fibrillation was associated with increased MCS use (OR 1.63; 95% CI 1.01-2.61; p = 0.044). Mortality was 27.6% without MCS vs 29.8% with MCS (p = 0.604). Older age (OR 1.04; p = 0.004) and anemia (OR 2.4; p = 0.041) predicted mortality.
Conclusions:
While identified cases of SCAD-CS rose significantly from 2016 to 2020, overall MCS utilization remained statistically stable. Future multicenter efforts are needed to determine which specific management strategy and MCS modality and is most adequate for this unique patient population.
