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Comparative Study
. 2016 Apr 26;67(16):1871-80.
doi: 10.1016/j.jacc.2016.02.025.

Ventricular Assist Device in Acute Myocardial Infarction

Deepak Acharya  1 , Renzo Y Loyaga-Rendon  2 , Salpy V Pamboukian  2 , José A Tallaj  2 , William L Holman  3 , Ryan S Cantor  4 , David C Naftel  3 , James K Kirklin  3
Affiliations
Comparative Study

Ventricular Assist Device in Acute Myocardial Infarction

Deepak Acharya et al. J Am Coll Cardiol. .

Abstract

Background: Patients with acute myocardial infarction (AMI) complicated by acute heart failure or cardiogenic shock have high mortality with conventional management.

Objectives: 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.

Keywords: cardiogenic shock; heart assist devices; left ventricular assist device; low cardiac output.

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Figures

Figure 1
Figure 1. Competing Outcomes in AMI Patients, INTERMACS Profile 1
Competing outcomes for AMI patients who were INTERMACS profile 1 at implant (n = 355). AMI = acute myocardial infarction; INTERMACS = Interagency Registry for Mechanically Assisted Circulatory Support.
Figure 2
Figure 2. Outcomes Stratified by Age
Competing outcomes curves for patients with AMI undergoing LVAD placement, stratified by age (<55: n = 187; 55 to 65: n = 206; >65: n = 109). Older patients had lower overall survival compared with younger patients. However, 1-month survival was similar between the 3 groups and survival differences were more prominent starting 3 months after LVAD implantation. AMI = acute myocardial infarction; LVAD = left ventricular assist device.
Figure 3
Figure 3. Outcomes by Device Type
Competing outcomes of patients with myocardial infarction receiving LVAD (n = 443), BIVAD (n = 33), or TAH (n = 26). Patients with TAH had high rates of early transplantation. BIVAD = biventricular assist device; LVAD = left ventricular assist device; TAH = total artificial heart.
Figure 4
Figure 4. Competing Outcomes in Non-AMI Patients
Competing outcomes of patients undergoing LVAD placement for non-AMI indications (n = 9,727).
Central Illustration
Central Illustration. Competing Outcomes in AMI Patients From June 23, 2006 to March 31, 2014
Competing outcomes post-VAD for patients with AMI (n = 502). AMI = acute myocardial infarction.
See this image and copyright information in PMC

Comment in

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