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2016 ; 67
(16
): 1871-80
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Ventricular Assist Device in Acute Myocardial Infarction
#MMPMID27102502
Acharya D
; Loyaga-Rendon RY
; Pamboukian SV
; Tallaj JA
; Holman WL
; Cantor RS
; Naftel DC
; Kirklin JK
J Am Coll Cardiol
2016[Apr]; 67
(16
): 1871-80
PMID27102502
show ga
BACKGROUND: Patients with acute myocardial infarction (AMI) complicated by acute
heart failure or cardiogenic shock have high mortality with conventional
management. OBJECTIVES: This study evaluated outcomes of patients with AMI who
received durable ventricular assist devices (VAD). METHODS: Patients in the
INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support)
registry who underwent VAD placement in the setting of AMI were included and
compared with patients who received VAD for non-AMI indications. RESULTS: VAD
were implanted in 502 patients with AMI: 443 left ventricular assist devices; 33
biventricular assist devices; and 26 total artificial hearts. Median age was 58.3
years, and 77.1% were male. At implantation, 66% were INTERMACS profile 1. A
higher proportion of AMI than non-AMI patients had pre-operative intra-aortic
balloon pumps (57.6% vs. 25.3%; p < 0.01), intubation (58% vs. 8.3%; p < 0.01),
extracorporeal membrane oxygenation (17.9% vs. 1.7%, p < 0.01), cardiac arrest
(33.5% vs. 3.3%, p < 0.01), and higher-acuity INTERMACS profiles. At 1 month
post-VAD, 91.8% of AMI patients were alive with ongoing device support, 7.2% had
died on device, and 1% had been transplanted. At 1-year post-VAD, 52% of AMI
patients were alive with ongoing device support, 25.7% had been transplanted,
1.6% had left VAD explanted for recovery, and 20.7% had died on device. The AMI
group had higher unadjusted early phase hazard (hazard ratio [HR]: 1.24; p =
0.04) and reduced late-phase hazard of death (HR: 0.57; p = 0.04) than the
non-AMI group did. After accounting for established risk factors, the AMI group
no longer had higher early mortality hazard (HR: 0.89; p = 0.30), but it had
lower late mortality hazard (HR: 0.55; p = 0.02). CONCLUSIONS: Patients with AMI
who receive VAD have outcomes similar to other VAD populations, despite being
more critically ill pre-implantation. VAD therapy is an effective strategy for
patients with AMI and acute heart failure or shock in whom medical therapy is
failing.
|*Registries
[MESH]
|Adult
[MESH]
|Age Factors
[MESH]
|Aged
[MESH]
|Chi-Square Distribution
[MESH]
|Female
[MESH]
|Heart Failure/diagnosis/mortality/surgery
[MESH]
|Heart-Assist Devices/adverse effects/*statistics & numerical data
[MESH]
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