Ventricular assist device in patients with ST-segment elevation myocardial infarction:insight from the united states national inpatient sample database.

Background:
ST-segment elevation myocardial infarction (STEMI) can be complicated by cardiogenic shock requiring temporary mechanical support, but a subgroup of those will require a durable ventricular assist device (VAD).

Methods:
We did a secondary analysis of the National Inpatient Sample (NIS) for the year 2007-2014. We included all patients who presented with the primary diagnosis of STEMI and cardiogenic shock. From this group, all patients underwent VAD implantation during same hospitalization were studied. We evaluated trend and outcomes of VAD, and mechanical support use prior to VAD placement in this cohort.

Results:
There were 165,515 STEMI hospitalization complicated with cardiogenic shock. Patients had median age of 66.8 ±13.2 years (66.6% white and 63.1% male). Of those, VAD were implanted in 1,184 patients (0.7%) with mean age of 54.8 ±11.2 years. Pre-operative temporary mechanical support was used in 43% as intra-aortic balloon pumps, 11.4% as percutaneous mechanical support (Tandem Heart & Impella), and 20.2% as extracorporeal membrane oxygenation (ECMO). Mean time to VAD implantation was 9±12 days. In hospital mortality post VAD placement was 28.5%.

Conclusions
Despite the technological and surgical technical advancement in VAD therapy, implantation of VAD has not increased significantly in critically ill STEMI patients with cariogenic shock. The rate of VAD implantation in the STEMI patient with cardiogenic shock remained constant and low (0.7%) from 2007 to 2014. The in-hospital mortality post VAD implantation still remained high (28.5%).