Ventricular Assist Device in Acute Myocardial Infarction.
BACKGROUND
Patients with acute myocardial infarction (AMI) complicated by acute heart failure or cardiogenic shock have high mortality with conventional management.


OBJECTIVE
This study evaluated outcomes of patients with AMI who received durable ventricular assist devices (VAD).


METHODS
Patients in the INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) registry who underwent VAD placement in the setting of AMI were included and compared with patients who received VAD for non-AMI indications.


RESULTS
VAD were implanted in 502 patients with AMI: 443 left ventricular assist devices; 33 biventricular assist devices; and 26 total artificial hearts. Median age was 58.3 years, and 77.1% were male. At implantation, 66% were INTERMACS profile 1. A higher proportion of AMI than non-AMI patients had pre-operative intra-aortic balloon pumps (57.6% vs. 25.3%; p < 0.01), intubation (58% vs. 8.3%; p < 0.01), extracorporeal membrane oxygenation (17.9% vs. 1.7%, p < 0.01), cardiac arrest (33.5% vs. 3.3%, p < 0.01), and higher-acuity INTERMACS profiles. At 1 month post-VAD, 91.8% of AMI patients were alive with ongoing device support, 7.2% had died on device, and 1% had been transplanted. At 1-year post-VAD, 52% of AMI patients were alive with ongoing device support, 25.7% had been transplanted, 1.6% had left VAD explanted for recovery, and 20.7% had died on device. The AMI group had higher unadjusted early phase hazard (hazard ratio [HR]: 1.24; p = 0.04) and reduced late-phase hazard of death (HR: 0.57; p = 0.04) than the non-AMI group did. After accounting for established risk factors, the AMI group no longer had higher early mortality hazard (HR: 0.89; p = 0.30), but it had lower late mortality hazard (HR: 0.55; p = 0.02).


CONCLUSIONS
Patients with AMI who receive VAD have outcomes similar to other VAD populations, despite being more critically ill pre-implantation. VAD therapy is an effective strategy for patients with AMI and acute heart failure or shock in whom medical therapy is failing.
Section of Advanced Heart Failure, Transplant, and Mechanical Circulatory Support, University of Alabama at Birmingham, Birmingham, Alabama. Electronic address: dacharya@uab.edu.
Deepak
D
Acharya
Section of Advanced Heart Failure, Transplant, and Mechanical Circulatory Support, University of Alabama at Birmingham, Birmingham, Alabama.
Renzo Y
RY
Loyaga-Rendon
Section of Advanced Heart Failure, Transplant, and Mechanical Circulatory Support, University of Alabama at Birmingham, Birmingham, Alabama.
Salpy V
SV
Pamboukian
Section of Advanced Heart Failure, Transplant, and Mechanical Circulatory Support, University of Alabama at Birmingham, Birmingham, Alabama.
José A
JA
Tallaj
Division of Cardiovascular Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
William L
WL
Holman
Division of Cardiovascular Surgery, University of Alabama at Birmingham, Birmingham, Alabama; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama.
Ryan S
RS
Cantor
Division of Cardiovascular Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
David C
DC
Naftel
Division of Cardiovascular Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
James K
JK
Kirklin
D000328:Adult; D000367:Age Factors; D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D006353:Heart-Assist Devices / Q000009:adverse effects / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States
cardiogenic shock; heart assist devices; left ventricular assist device; low cardiac output