Mechanical Circulatory Support in Myocardial Infarction Complicated by Cardiogenic Shock: Impact of Sex and Timing.

BACKGROUND

Sex differences in presentation, treatment, and outcomes persist in patients with acute myocardial infarction complicated by cardiogenic shock (AMICS). Sex-based outcomes of patients with AMICS undergoing percutaneous coronary intervention (PCI) with percutaneous left ventricular assist device (pLVAD) support are poorly defined.

METHODS

From January 2017 to August 2019, consecutive patients undergoing PCI who received Impella support within 48 ​hours of myocardial infarction were enrolled in the prospective RECOVER III postmarket registry. In-hospital survival and predictors of mortality were compared by sex.

RESULTS

A total of 358 patients (276 men and 82 women) were included. Women had lower baseline mean arterial pressure and shorter duration of pLVAD support compared with men. In-hospital adverse events were similar in women and men, including mortality (54% versus 46%, = .25), major bleeding (11% versus 10%, = .83), and vascular complications requiring surgery (8.5% versus 4%, = .10). Women had better survival with pre-PCI versus post-PCI pLVAD implantation (59% versus 34%, = .03), whereas survival in men was similar regardless of pre- versus post-PCI pLVAD support (56% versus 50%, = .39). The number of inotrope/vasopressor use pre-pLVAD was the strongest predictor of mortality in women (OR 3.03, = .01) but not in men (OR 1.18, = .25).

CONCLUSIONS

Survival of patients with AMICS treated with PCI and Impella support was 52% at hospital discharge and was similar for women and men. Women with AMICS may derive greater benefit from early pLVAD support prior to escalation of inotrope/vasopressors and had no evidence of increased risk of access-related complications.