Ventricular Assist Device in Acute Myocardial Infarction
What are the outcomes of patients with durable ventricular assist devices (VADs) implanted in the setting of acute myocardial infarction (AMI)?
A retrospective analysis using data from the INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) registry was performed to compare outcomes in patients who underwent VAD for MI versus VAD for other causes. The INTERMACS is a prospective national registry comprised of Food and Drug Administration approved durable mechanical circulatory support (MCS) devices implanted in the United States.
A total of 502 patients in 105 hospitals underwent VAD implantation for AMI compared to 9,727 patients in 143 hospitals who underwent VAD for other reasons. Patients with AMI had a higher prevalence of risk factors related to coronary artery disease, but were comparable in terms of age and gender. The patients with AMI were sicker, with 66.7% being implanted, while INTERMACS profile 1 compared to only 12.9% of non-MI patients. Patients implanted for AMI had a substantially higher prevalence of intra-aortic balloon pump, extracorporeal membrane oxygenation, and ventilatory support, and a higher prevalence of biventricular support (BiVADs and total artificial heart). Patients with AMI had a significantly higher rate of early complications. At 1 year, 52% of VAD patients who had AMI were alive with ongoing VAD support, 25.7% had been transplanted, 1.6% explanted for recovery, and 20.7% died on a device. Patients with AMI had similar adjusted early hazard (hazard ratio [HR], 0.89; p = 0.3) and lower adjusted late hazard for mortality (HR, 0.55; p = 0.02) when compared to those implanted for indications other than AMI.
Durable VADs implanted in the setting of AMI provide comparable outcomes to VADs implanted in patients without AMI.
Durable VAD therapy can be an effective option to rescue patients with AMI and cardiogenic shock; however, complications are common in the early period, and long-term mortality remains high.
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