Mechanical circulatory assistance in myocardial infarction with refractory cardiogenic shock: clinical experience in 10 patients at a teaching hospital in Rouen

SummaryBackgroundIn patients with acute myocardial infarction (MI), cardiogenic shock (CS) remains associated with a high mortality (close to 50%) despite optimal therapeutic strategy. For those patients who are unlikely to survive, mechanical circulatory support (MCS) might be an additional life saving strategy.ObjectiveTo evaluate the efficacy of circulatory assistance in myocardial infarction complicated by cardiogenic shock.MethodsWe retrospectively studied the characteristics and clinical outcome of 10 patients hospitalized with acute MI and CS who required MCS. Mean age was 52±8 years; location of MI was anterior in 80% of cases. Immediate coronary angiography was performed in all cases 5.8±7.0hours from the onset of symptoms. Intra-aortic balloon pumping was used in 70% of patients and 30% received thrombolysis. Angioplasty with stent implantation was performed in 8 patients.ResultsIn all patients MCS was placed within a mean of 57±92hours after admission for hemodynamic instability (systolic aortic pressure: 85±13mmHg; mean: 64±10mmHg). Extracorporeal membrane oxygenation (ECMO) was implanted in 8 patients followed by Thoratec™ in one. The other 2 patients received a Thoratec™ and a Heartmate II™ system respectively. Survival rate was 40% (4 patients): 3 patients underwent heart transplantation at a mean of 93±97 days and one patient is alive with definitive implantable Heartmate™. The other six patients died in hospital.ConclusionMechanical circulatory support appeared life saving in 4 out of 10 patients with acute MI and cardiogenic shock refractory to optimal treatment. In this situation, circulatory assistance deserves discussion and the choice of optimal device should be further evaluated