Journal of cardiovascular medicine (Hagerstown, Md.) · 2026
Durable ventricular assist device implantation after acute myocardial infarction: an analysis of the EUROMACS registry.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Pieri Marina, Altizio Savino, Pontillo Domenico, Schoenrath Felix, Consolo Filippo, Ajello Silvia, Scandroglio Anna Mara
Аннотация
INTRODUCTION: Patients undergoing durable ventricular assist device (VAD) implantation after acute myocardial infarction (AMI) present critical surgical and clinical challenges. Data on outcomes in this high-risk population remain limited. The aim of this study was to describe the clinical profile and identify predictors of long-term outcomes in AMI patients receiving durable VAD support.
METHODS: Retrospective analysis of patients included in the EUROMACS registry (1995-2024) was conducted.
RESULTS: Three hundred and thirty-five patients (4.8% of EUROMACS records) underwent VAD implantation post-AMI. Most patients presented with severe cardiogenic shock (82% INTERMACS class 1-2), and the median time from AMI hospitalization to VAD implantation was 9 (IQR 8-14) days. Surgical revision for bleeding was required in 20% of patients. Mortality risk was 31% at 1 year, 46% at 5 years and 56% at 10 years. At multivariable analysis, female sex [subdistribution hazard ratio (SHR): 2.70, 95% confidence interval (95% CI): 1.62-4.49, P = 0.016], mechanical ventilation (SHR: 2.16, 95% CI: 1.44-3.26, P < 0.001) and VAD implantation as destination therapy (SHR: 2.48, 95% CI: 1.69-3.64, P < 0.001) were independent predictors of mortality, while a recent year of implant (SHR: 0.84, 95% CI: 0.73-0.97, P = 0.016) increasing BMI (SHR: 0.96, 95% CI: 0.94-0.99, P = 0.014), no previous history of heart failure (SHR: 0.61, 95% CI: 0.42-0.91, P = 0.014) and the presence of sinus rhythm (SHR: 0.63, 95% CI: 0.43-0.92, P = 0.017) were protective factors against mortality.
CONCLUSION: AMI patients accounted for a small subset of durable VAD recipients in an all-comers international registry, with high cardiogenic shock severity and substantial mortality risk. These findings provide a rationale for future prospective studies aimed at optimizing management and outcomes in this vulnerable population.
METHODS: Retrospective analysis of patients included in the EUROMACS registry (1995-2024) was conducted.
RESULTS: Three hundred and thirty-five patients (4.8% of EUROMACS records) underwent VAD implantation post-AMI. Most patients presented with severe cardiogenic shock (82% INTERMACS class 1-2), and the median time from AMI hospitalization to VAD implantation was 9 (IQR 8-14) days. Surgical revision for bleeding was required in 20% of patients. Mortality risk was 31% at 1 year, 46% at 5 years and 56% at 10 years. At multivariable analysis, female sex [subdistribution hazard ratio (SHR): 2.70, 95% confidence interval (95% CI): 1.62-4.49, P = 0.016], mechanical ventilation (SHR: 2.16, 95% CI: 1.44-3.26, P < 0.001) and VAD implantation as destination therapy (SHR: 2.48, 95% CI: 1.69-3.64, P < 0.001) were independent predictors of mortality, while a recent year of implant (SHR: 0.84, 95% CI: 0.73-0.97, P = 0.016) increasing BMI (SHR: 0.96, 95% CI: 0.94-0.99, P = 0.014), no previous history of heart failure (SHR: 0.61, 95% CI: 0.42-0.91, P = 0.014) and the presence of sinus rhythm (SHR: 0.63, 95% CI: 0.43-0.92, P = 0.017) were protective factors against mortality.
CONCLUSION: AMI patients accounted for a small subset of durable VAD recipients in an all-comers international registry, with high cardiogenic shock severity and substantial mortality risk. These findings provide a rationale for future prospective studies aimed at optimizing management and outcomes in this vulnerable population.