Timing of Mechanical Circulatory Support and In-Hospital Mortality in Patients With Cardiogenic Shock

To evaluate the association between early mechanical circulatory support (MCS) use and mortality in patients with cardiogenic shock (CS).

We identified adults aged 18 years or older hospitalized from October 1, 2015, to June 30, 2023, with a diagnosis of CS. Patients receiving MCS within the first 2 days of admission were included in the study. Using inverse probability of treatment weighting, we assessed the association between receiving MCS on day 1 vs day 2 and in-hospital mortality.

Among 69,085 patients, 75.7% (n=52,307) and 24.3% (n=16,778) received MCS on day 1 and day 2, respectively. Devices included the intra-aortic balloon pump (62.9% [n=43,467]), percutaneous left ventricular assist device (25.0% [n=17,236]), and extracorporeal membrane oxygenation (22.0% [n=14,920]). The unadjusted mortality was 38.7% (n= 20,225 of 52,307) and 37.9% (n= 6,353 of 16,778) for MCS use on day 1 vs day 2, respectively (P=.06). After inverse probability of treatment weighting, MCS on day 1 was associated with a 7.4% (weighted mean; 95% CI, -8.4% to -6.4%; P<.001) reduction in mortality. Results persisted when each device was assessed separately and among patients presenting with acute myocardial infarction or heart failure as the shock etiology (all P<.001). When assessed by admission Society for Cardiovascular Angiography and Interventions shock stage, MCS on day 1 remained associated with lower mortality for each stage (stage C, -11.1%; 95% CI, -12.4 to -9.8%; stage D, -9.1%; 95% CI, -10.8% to -7.3%; stage E, -2.7%; 95% CI, -5.0% to -0.4%).

For patients with CS, MCS on the first compared with the second day of admission was associated with a lower in-hospital mortality.