Prognosis in Patients With Cardiogenic Shock Who Received Temporary Mechanical Circulatory Support.

Background: Temporary mechanical circulatory support (MCS) is often used in patients with cardiogenic shock (CS), and the type of MCS may vary by cause of CS.
Objectives: This study sought to describe the causes of CS in patients receiving temporary MCS, the types of MCS used, and associated mortality.
Methods: This study used a nationwide Japanese database to identify patients receiving temporary MCS for CS between April 1, 2012, and March 31, 2020.
Results: Of 65,837 patients, the cause of CS was acute myocardial infarction (AMI) in 77.4%, heart failure (HF) in 10.9%, valvular disease in 2.7%, fulminant myocarditis (FM) in 2.5%, arrhythmia in 4.5%, and pulmonary embolism (PE) in 2.0% of cases. The most commonly used MCS was an intra-aortic balloon pump alone in AMI (79.2%) and in HF (79.0%) and in valvular disease (66.0%), extracorporeal membrane oxygenation with intra-aortic balloon pump in FM (56.2%) and arrhythmia (43.3%), and extracorporeal membrane oxygenation alone in PE (71.5%). Overall in-hospital mortality was 32.4%; 30.0% in AMI, 32.6% in HF, 33.1% in valvular disease, 34.2% in FM, 60.9% in arrhythmia, and 59.2% in PE. Overall in-hospital mortality increased from 30.4% in 2012 to 34.1% in 2019. After adjustment, valvular disease, FM, and PE had lower in-hospital mortality than AMI: valvular disease, OR: 0.56 (95% CI: 0.50-0.64); FM: OR: 0.58 (95% CI: 0.52-0.66); PE: OR: 0.49 (95% CI: 0.43-0.56); whereas HF had similar in-hospital mortality (OR: 0.99; 95% CI: 0.92-1.05) and arrhythmia had higher in-hospital mortality (OR: 1.14; 95% CI: 1.04-1.26).
Conclusions: In a Japanese national registry of patients with CS, different causes of CS were associated with different types of MCS and differences in survival.
Competing Interests: This study was supported by grant from Fukuda Foundation for Medical Technology. Drs McMurray and Petrie are supported by British Heart Foundation Centre of Research Excellence Grant RE/18/6/34217. Dr Kondo has received lecture fees from Ono Pharmaceutical Co, Ltd, Otsuka Pharmaceutical Co, Ltd, Novartis Pharma KK, AstraZeneca KK, Bristol Myers Squibb Co, and Abiomed Japan KK. Dr. Okumura has received research grants from Ono Pharma Co, Ltd, Pfizer Japan Inc, Amgen Astellas BioPharma KK, Alnylam, and Alexion; and has received honoraria from Ono Pharma Co, Ltd, Otsuka Pharma Co, Ltd, Novartis Pharma KK, and AstraZeneca. Dr. Butt has received advisory board honoraria from Bayer. Dr McMurray has received compensation paid to his employer, Glasgow University, for his work on clinical trials, consulting, and other activities from Alnylam, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb Co, Cardurion, Cytokinetics, Dal-Cor, GlaxoSmithKline, Ionis, KBP Biosciences, Novartis, Pfizer, Theracos; and has received personal lecture fees from Abbott, Alkem Metabolics, AstraZeneca, Eris Lifesciences, Hikma, Lupin, Sun Pharmaceuticals, Medscape/Heart.Org, ProAdWise Communications, S&L Solutions Event Management Inc, Radcliffe Cardiology, Servier, the Corpus, Translational Medical Academy, Web MD, and (as Director) the Global Clinical Trial Partners Ltd. Dr Murohara has received lecture fees from Bayer Pharma Co, Ltd, Daiichi Sankyo Co, Ltd, Dainippon Sumitomo Pharma Co, Ltd, Kowa Co, Ltd, Merck Sharp & Dohme KK, Mitsubishi Tanabe Pharma Co, Nippon Boehringer Ingelheim Co, Ltd, Novartis Pharma KK, Pfizer Japan Inc, Sanofi-Aventis KK, and Takeda Pharma Co, Ltd; and has received an unrestricted research grants from the Department of Cardiology, Nagoya University Graduate School of Medicine, as well as from Astellas Pharma Inc, Daiichi Sankyo Co, Ltd, Dainippon Sumitomo Pharma Co, Ltd, Kowa Co, Ltd, Merck Sharp & Dohme KK, Mitsubishi Tanabe Pharma Co, Nippon Boehringer Ingelheim Co, Ltd, Novartis Pharma KK, Otsuka Pharma Ltd, Pfizer Japan Inc, Sanofi-Aventis KK, Takeda Pharma Co, Ltd, and Teijin Pharma Ltd. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
(© 2023 The Authors.)