Trends and outcomes of different mechanical circulatory support modalities for refractory cardiogenic shock in Takotsubo cardiomyopathy

Abstract

Background

The use of mechanical circulatory support (MCS) devices in cardiogenic shock is growing. We aim to study trends and compare different MCS modalities in this population.

Methods

The National Readmission Database (2016-2020) was queried to identify TTC-CS requiring MCS. Cohorts were stratified as ECMO (extracorporeal membrane oxygenation) compared to other short-term percutaneous left ventricular assist devices (Impella). The propensity score matching (PSM) was used to remove confounders. Pearson’s x2 test was applied to PSM-matched cohorts to compare outcomes. Additionally, we used multivariate regression and reported predictive margins for adjusted trend analysis.

Results

Among 2,025 TTC-CS hospitalizations requiring MCS, 1,790 required Impella vs. 235 on ECMO. ECMO was more common in metropolitan teaching hospitals (72.2 % vs 56.1 %, p < 0.05). On PSM cohorts (N = 131), ECMO had higher in-hospital mortality (38.9 % vs. 20.6 %, p < 0.001), major bleeding (15.3 % vs. 2.3 %, p < 0.001), acute blood loss anemia (48.9 % vs. 19.1 %, p < 0.001) among others. Our subgroup analysis comparing ECMO when Left ventricular (LV) unloading was provided by either IABP or Impella, and Impella alone showed no difference in the short-term mortality (42.2 % vs. 33.3 %, p: 0.384). However, the rates of major bleeding (17.8 % vs. 0.0 %, p: 0.003) and acute blood loss anemia (55.6 % vs. 22.2 %, p: 0.001) were higher for ECMO cohort.

Conclusion

In the absence of LV unloading, the ECMO utilization in TTC-CS had higher mortality and adverse events than Impella. The mortality difference was nonsignificant when concomitant LV unloading was provided with Impella or IABP in these patients.