title: Important role of mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock.
abstract: OBJECTIVE
  Acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) remains associated with significant mortality despite the widespread application of early revascularization strategies. Recent evidence suggests that the use of intra-aortic balloon pump (IABP) counterpulsation does not improve mortality in this cohort of patients. We summarize our experience with mechanical circulatory support (MCS) therapy for AMI/CS.
  
  
  METHODS
  This is a retrospective review of 61 patients who received MCS therapy for AMI/CS at our institution between March 2007 and March 2013.
  
  
  RESULTS
  Mean age was 60.2 ± 10.3 years; mean ejection fraction was 24 ± 15% and 29% of patients were receiving active cardiopulmonary resuscitation at the time of support initiation. Prior to the initiation of MCS, 70.5% of patients had an IABP. Mean arterial pressure improved significantly with MCS (63 mmHg prior to MCS, 82 mmHg after MCS, P ≤ 0.01). Mean length of support was 9.5 ± 11.0 days, and overall survival to 30 days was 59.0%. Among 30-day survivors, 44.4% required device exchange to a durable MCS device. Ultimately, only 31% (52.8% of patients who survived to 30 days) achieved myocardial recovery.
  
  
  CONCLUSIONS
  Short-term MCS therapy with subsequent aggressive use of durable MCS device may improve the unacceptably high mortality rate in AMI/CS. Rigorous prospective studies of MCS therapy in AMI/CS are warranted.
authors.affiliation: Department of Surgery, Columbia University Medical Center, New York, NY, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Truby
authors.affiliation: Department of Surgery, Columbia University Medical Center, New York, NY, USA.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
authors.affiliation: Department of Surgery, Columbia University Medical Center, New York, NY, USA.
authors.forename: Bindu
authors.initials: B
authors.lastname: Kalesan
authors.affiliation: Department of Surgery, Columbia University Medical Center, New York, NY, USA.
authors.forename: Takeyoshi
authors.initials: T
authors.lastname: Ota
authors.affiliation: Department of Medicine, Columbia University Medical Center, New York, NY, USA.
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
authors.affiliation: Department of Medicine, Columbia University Medical Center, New York, NY, USA.
authors.forename: Susheel
authors.initials: S
authors.lastname: Kodali
authors.affiliation: Department of Surgery, Columbia University Medical Center, New York, NY, USA.
authors.forename: Natasha
authors.initials: N
authors.lastname: Nikic
authors.affiliation: Department of Surgery, Columbia University Medical Center, New York, NY, USA.
authors.forename: Lily
authors.initials: L
authors.lastname: Mundy
authors.affiliation: Department of Medicine, Columbia University Medical Center, New York, NY, USA.
authors.forename: Paolo
authors.initials: P
authors.lastname: Colombo
authors.affiliation: Department of Medicine, Columbia University Medical Center, New York, NY, USA.
authors.forename: Ulrich P
authors.initials: UP
authors.lastname: Jorde
authors.affiliation: Department of Surgery, Columbia University Medical Center, New York, NY, USA hirofu2@hotmail.com.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
mesh_terms: D000368:Aged; D001243:Assisted Circulation / Q000379:methods*; D005260:Female; D006353:Heart-Assist Devices; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000379:methods; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome
keywords: Acute myocardial infarction; Mechanical circulatory support