Comparison of Outcomes in Patients with Acute Myocardial Infarction Complicated with Cardiogenic Shock Treated with Ecpella Versus Va-ecmo with Iabp

Cardiogenic shock (CS) is a severe complication of acute myocardial infarction (AMI). However, mechanical circulatory support (MCS) such as VA-ECMO plus Impella (ECPELLA) and VA-ECMO plus IABP has been shown to improve outcomes in these patients. There is a paucity of data comparing the outcomes between these two MCS strategies. We sought to investigate the outcomes in patients with AMI complicated with CS requiring ECPELLA versus VA-ECMO plus IABP. We conducted a retrospective study of patients with AMI complicated with CS who underwent MCS with either ECPELLA or VA-ECMO plus IABP between 2016 and 2020, using the Nationwide Readmissions Database. The primary outcome was inpatient mortality, while secondary outcomes were, 30-day readmission (30-dr), length of stay (LOS), and resource utilization defined by hospital charge. Multivariate linear, Cox, and logistic regression analyses were performed. A p-value <0.05 was considered statistically significant Between 2016 and 2020 1,251 patients with AMI complicated with CS and treated with VA-ECMO were identified. The mean age was 59.7 ± 8.2 years and 75.6% (n = 946) were males. Of these, 53% (n = 661) were in the ECPELLA group. The mean age was 60.9 ± 8.1 years in the ECPELLA group versus 58.8 ± 8.3 years in the VA-ECMO plus IABP group (adjusted Wald test, p = 0.12). Multivariate logistic regression models adjusting for other clinical variables showed no significant difference in 30-dr (OR 1.24 95% CI 0.40 - 3.82, p = 0.71) and LOS (16.0 days vs. 19.8 days, adjusted Wald test, p = 0.11) between the two groups. The ECPELLA group had higher HCs ($124,065,155 vs. $76,074,753, adjusted Wald test, p < 0.03) when compared to the VA-ECMO plus IABP group. Cox regression analysis revealed a higher hazard ratio for inpatient mortality (HR 1.67 95% CI 1.17 - 2.40, p < 0.01) in the ECPELLA group compared to the VA-ECMO plus IABP group. Our data showed that ECPELLA was associated with higher in-hospital mortality compared to VA-ECMO plus IABP. These findings may suggest that VA-ECMO plus IABP may be a better strategy for this patient population. However, prospective randomized trials are required to confirm these results. Cardiogenic shock (CS) is a severe complication of acute myocardial infarction (AMI). However, mechanical circulatory support (MCS) such as VA-ECMO plus Impella (ECPELLA) and VA-ECMO plus IABP has been shown to improve outcomes in these patients. There is a paucity of data comparing the outcomes between these two MCS strategies. We sought to investigate the outcomes in patients with AMI complicated with CS requiring ECPELLA versus VA-ECMO plus IABP. We conducted a retrospective study of patients with AMI complicated with CS who underwent MCS with either ECPELLA or VA-ECMO plus IABP between 2016 and 2020, using the Nationwide Readmissions Database. The primary outcome was inpatient mortality, while secondary outcomes were, 30-day readmission (30-dr), length of stay (LOS), and resource utilization defined by hospital charge. Multivariate linear, Cox, and logistic regression analyses were performed. A p-value <0.05 was considered statistically significant Between 2016 and 2020 1,251 patients with AMI complicated with CS and treated with VA-ECMO were identified. The mean age was 59.7 ± 8.2 years and 75.6% (n = 946) were males. Of these, 53% (n = 661) were in the ECPELLA group. The mean age was 60.9 ± 8.1 years in the ECPELLA group versus 58.8 ± 8.3 years in the VA-ECMO plus IABP group (adjusted Wald test, p = 0.12). Multivariate logistic regression models adjusting for other clinical variables showed no significant difference in 30-dr (OR 1.24 95% CI 0.40 - 3.82, p = 0.71) and LOS (16.0 days vs. 19.8 days, adjusted Wald test, p = 0.11) between the two groups. The ECPELLA group had higher HCs ($124,065,155 vs. $76,074,753, adjusted Wald test, p < 0.03) when compared to the VA-ECMO plus IABP group. Cox regression analysis revealed a higher hazard ratio for inpatient mortality (HR 1.67 95% CI 1.17 - 2.40, p < 0.01) in the ECPELLA group compared to the VA-ECMO plus IABP group. Our data showed that ECPELLA was associated with higher in-hospital mortality compared to VA-ECMO plus IABP. These findings may suggest that VA-ECMO plus IABP may be a better strategy for this patient population. However, prospective randomized trials are required to confirm these results.