Outcomes of Mechanical Circulatory Support Devices Among Patients with Mechanical Complications of Acute Myocardial Infarction.

Abstract

Background: Mechanical complications of acute myocardial infarction (AMI) are rare but associated with considerably high mortality. While guidelines suggest mechanical circulatory support (MCS) devices as a potential bridge to definitive therapy, studies supporting this recommendation are limited.

Methods: Using data from the National Inpatient Sample, a large admirative database in the United States, years 2016-2020, we identified AMI admissions (ST-elevation and non-ST-elevation myocardial infarction) with mechanical complications (ventricular septal defect, free wall rupture, or papillary muscle rupture). Logistic regression models adjusting for potential confounders were used to assess temporal trends in MCS utilization and to compare in-hospital mortality between those who received MCS versus none.

Results: Among 4,450,219 AMI patients, 7,025 (0.2%) had a mechanical complication of which, 3,115 patients (44.3%) received at least one MCS device. There was a rising trend in MCS use (39.3% in 2016 to 48.9% in 2020, Ptrend=0.02), but there was no corresponding reduction in the incidence of in-hospital mortality (36.9% in 2016 vs 43.4% in 2020, Ptrend=0.75). There was no significant difference in in-hospital mortality between those who received MCS versus those who did not (48.4 vs 34.5% respectively.

Conclusions: In this large observational analysis of AMI hospitalizations, mechanical complications were rare and associated with very high in-hospital mortality. Although the use of MCS has increased, however, in-hospital mortality rates remain high even among patients who received MCS. Further investigations are needed to clarify the role of MCS devices among patients with mechanical complications of AMI.