Ventricular Assist Device in Acute Myocardial Infarction #MMPMID27102502
Achary 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 PMID27102502show ga
Background: Patients with acute myocardial infarction (AMI) complicated by acute heart failure or cardiogenic shock have high mortality with conventional management. Objectives: We evaluated outcomes of patients with AMI who received durable ventricular assist devices (VADs). Methods: Patients with AMI in the INTERMACS registry who underwent VAD placement were included and compared to patients who received VADs for non-AMI indications. Results: VADs 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 implant, 66% were INTERMACS profile 1. A higher proportion of AMI than non- AMI patients had preoperative 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 LVADs explanted for recovery, and 20.7% had died on device. The AMI group had higher unadjusted early-phase hazard (HR: 1.24; p = 0.04) and reduced late-phase hazard of death (HR: 0.57; p = 0.04) than the non-AMI group. After accounting for established risk factors, the AMI group no longer had higher early mortality hazard (HR: 0.89; p = 0.3), but had lower late mortality hazard (HR: 0.55; p = 0.02). Conclusion: Patients with AMI who receive VADs have outcomes similar to other VAD populations, despite being more critically ill pre-implantation. VAD therapy is an effective strategy for patients with AMI in whom medical therapy is failing.
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J+Am+Coll+Cardiol 2016 ; 67 (16): 1871-80
