Trends and Outcomes of Mechanical Circulatory Support in Acute Myocardial Infarction and Cardiogenic Shock Patients Undergoing Coronary Artery Bypass Grafting.

Abstract

We sought to describe trends and outcomes of mechanical circulatory support (MCS) use in acute myocardial infarction and cardiogenic shock (AMI-CS) patients undergoing coronary artery bypass grafting (CABG). We identified all patients with AMI-CS undergoing CABG in The Society of Thoracic Surgeons Adult Cardiac Surgery Database from 2011 to 2022. Preoperative, intraoperative, and postoperative use of intra-aortic balloon pump (IABP), catheter-based temporary MCS (tMCS), and extracorporeal membrane oxygenation (ECMO) were examined using multivariable regression and trends analyses. The primary outcome was operative mortality. During the study period, 34,015 patients with AMI-CS underwent CABG. The annualized volume ranged from 2964 in 2011 to 2646 in 2022, and operative mortality decreased from 24.2% in 2011 to 19.0% in 2022 (P for trend <.001). Preoperatively, IABP was used in 23,833 patients (70.1%), tMCS in 2173 patients (6.4%), ECMO in 173 patients (0.5%), and multiple devices in 499 (1.5%). Preoperative IABP use decreased from 2210 (74.6%) in 2011 to 1710 (64.6%) in 2022, and preoperative tMCS use increased from 38 (1.3%) in 2011 to 298 (11.3%) in 2022. Preoperative ECMO (P for trend = .004) or multiple device use (P for trend <.001) remained rare but increased over time. Preoperative IABP use was associated with lower operative mortality (18.0% vs 24.4%; adjusted odds ratio, 0.76; 95% CI, 0.71-0.82; P < .001). Operative mortality in AMI-CS patients undergoing CABG has decreased, while operative volumes have remained stable. IABP remains the most frequently used MCS, although its usage is declining in favor of tMCS.