Understanding patients with mechanical circulatory support for cardiogenic shock: The role of preceding cardiac arrest.

Abstract

Patients receiving mechanical circulatory support (MCS) for myocardial infarction-related cardiogenic shock (AMICS) often have a preceding out-of-hospital cardiac arrest (OHCA). This study aimed to clarify the association between OHCA and patient profiles, clinical course and outcomes in this population. Using data from the Netherlands Heart Registration (NHR) PCI Registry, we examined a real-world AMICS cohort that underwent PCI and received MCS between 2017 and 2021 across nine hospitals. Patients were classified as OHCA or non-OHCA. Univariable and multivariable logistic regression analyses were used to identify predictors of 30-day mortality. A total of 241 patients were included, with a mean age of 59.7 years and 78.0% being male. Half of the patients had a preceding OHCA (49.4%, n = 119). OHCA patients had a better pre-existing condition, a more acute presentation and less frequent multivessel disease. Thirty-day mortality rates were comparable between OHCA and non-OHCA patients (63.0% vs. 61.2%, p = 0.869). In the overall cohort, age, lactate, intubation and multivessel disease were independently associated with 30-day mortality. Among OHCA patients, age and lactate lost predictive value, whereas resuscitation longer than 30 min, an initial non-shockable rhythm, and multivessel disease were strongly associated with mortality. In non-OHCA patients, age, lactate and in-hospital cardiac arrest were predictive, while multivessel disease was not associated with 30-day mortality. Although 30-day mortality rates were comparable, determinants of mortality differed between OHCA and non-OHCA patients. This study highlights the importance of distinguishing between OHCA and non-OHCA, and emphasises that OHCA alone should not be a contraindication for MCS or MCS-evaluating trials.