Wu Jing, Li Chenguang, Xu Zheng, Wang Baoguo, Zhang Mingyou
Department of Translational Medicine, The First Hospital of Jilin University, Changchun, China.
Department of Cardiology, Zhongshan Hospital, Shanghai, China.
Sci Rep. 2025 Jul 14;15(1):25402. doi: 10.1038/s41598-025-10555-4.
There is limited data on the risk of stroke in patients with acute myocardial infarction (AMI) treated with temporary mechanical circulatory support devices. Retrospective data were extracted from the U.S. National Inpatient Sample between October 2015 and December 2020, involving hospitalizations for AMI. The final cohort comprised: 4,370,069 hospitalizations with medical therapy only, 136,005 with intra-aortic balloon pump (IABP) only, 41,560 with Impella only, and 10,695 with extracorporeal membrane oxygenation (ECMO) utilized during hospitalization. The overall stroke rates for patients receiving medical therapy only, IABP only, Impella only, and ECMO were 3.39%, 3.56%, 4.54%, and 13.14%, respectively. Specifically, ischemic stroke rates were 2.93%, 3.17%, 3.96%, and 9.91%, and hemorrhagic stroke rates were 0.69%, 0.59%, 0.87%, and 4.77% for the respective groups. In stepwise forward Cox regression analysis, ECMO use was associated with the highest adjusted odds ratio (aOR) for overall stroke (aOR 3.04, 95% CI [2.66-3.48]), followed by Impella alone (aOR 1.79, 95% CI [1.61-2.00]) and atrial fibrillation (aOR 1.34, 95% CI [1.31-1.38]). However, IABP use showed no significant association with increased stroke risk in either univariate or multivariate analyses. While IABP use is not associated with an increased risk of ischemic or hemorrhagic stroke, ECMO and Impella use are linked to a higher stroke risk, particularly for ECMO-treated AMI.
关于使用临时机械循环支持装置治疗的急性心肌梗死（AMI）患者发生中风风险的数据有限。回顾性数据取自2015年10月至2020年12月期间的美国国家住院样本，涉及AMI住院病例。最终队列包括：仅接受药物治疗的住院病例4370069例、仅使用主动脉内球囊反搏（IABP）的136005例、仅使用Impella的41560例以及住院期间使用体外膜肺氧合（ECMO）的10695例。仅接受药物治疗、仅使用IABP、仅使用Impella和使用ECMO的患者总体中风发生率分别为3.39%、3.56%、4.54%和13.14%。具体而言，各相应组的缺血性中风发生率分别为2.93%、3.17%、3.96%和9.91%，出血性中风发生率分别为0.69%、0.59%、0.87%和4.77%。在逐步向前Cox回归分析中，使用ECMO与总体中风的最高调整后比值比（aOR）相关（aOR 3.04，95%置信区间[2.66 - 3.48]），其次是单独使用Impella（aOR 1.79，95%置信区间[1.61 - 2.00]）和心房颤动（aOR 1.34，95%置信区间[1.31 - 1.38]）。然而，在单变量或多变量分析中，使用IABP与中风风险增加均无显著关联。虽然使用IABP与缺血性或出血性中风风险增加无关，但使用ECMO和Impella与较高的中风风险相关，尤其是对于接受ECMO治疗的AMI患者。
