Journal of thrombosis and thrombolysis · 2026
Antithrombotic strategies and outcomes in acute myocardial infarction-related cardiogenic shock requiring short-term mechanical circulatory support.
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Almeida Carvalho Rita, Presume João, Bello Ana Rita, Strong Christopher, Ferreira Jorge, Brízido Catarina
Аннотация
BACKGROUND: Cardiogenic shock following acute myocardial infarction (AMI-CS) is associated with high mortality. Short-term mechanical circulatory support (ST-MCS) is frequently used after percutaneous coronary intervention (PCI) to stabilize hemodynamics. However, balancing anticoagulation (AC) and antiplatelet therapy in this setting poses substantial bleeding risk.
OBJECTIVES: This study aimed to evaluate real-world antithrombotic strategies and associated ischemic and hemorrhagic complications in AMI-CS patients receiving ST-MCS.
METHODS: This retrospective, single-center study included all consecutive AMI-CS patients who underwent PCI and required ST-MCS between January 2017 and October 2024. AC and antiplatelet regimens were recorded from ST-MCS initiation until shock resolution. Ischemic and hemorrhagic events during this period were analyzed. The primary composite clinical endpoint was major adverse cardiovascular events (MACE), defined as a composite of ischemic events and all-cause mortality occurring during the period of cardiogenic shock.
RESULTS: Among 71 patients with AMI-CS who underwent PCI and required ST-MCS (mean age 62 ± 13 years, 69% male), in-hospital mortality was 56%, and MACE occurred in 42%. At ST-MCS initiation, 79% received triple therapy, decreasing to 39% by Day 7. Ischemic events were infrequent (8%) and mainly cerebrovascular. No cases of recurrent myocardial infarction or stent thrombosis were observed. Major bleeding (BARC ≥ 3) occurred in 32% of patients, typically within the first 48 h, and was more frequent in those supported with VA-ECMO.
CONCLUSION: In AMI-CS patients requiring ST-MCS, ischemic events were uncommon, whereas major bleeding was frequent and occurred early. These findings underscore the need for individualized antithrombotic strategies in this high-risk population.
OBJECTIVES: This study aimed to evaluate real-world antithrombotic strategies and associated ischemic and hemorrhagic complications in AMI-CS patients receiving ST-MCS.
METHODS: This retrospective, single-center study included all consecutive AMI-CS patients who underwent PCI and required ST-MCS between January 2017 and October 2024. AC and antiplatelet regimens were recorded from ST-MCS initiation until shock resolution. Ischemic and hemorrhagic events during this period were analyzed. The primary composite clinical endpoint was major adverse cardiovascular events (MACE), defined as a composite of ischemic events and all-cause mortality occurring during the period of cardiogenic shock.
RESULTS: Among 71 patients with AMI-CS who underwent PCI and required ST-MCS (mean age 62 ± 13 years, 69% male), in-hospital mortality was 56%, and MACE occurred in 42%. At ST-MCS initiation, 79% received triple therapy, decreasing to 39% by Day 7. Ischemic events were infrequent (8%) and mainly cerebrovascular. No cases of recurrent myocardial infarction or stent thrombosis were observed. Major bleeding (BARC ≥ 3) occurred in 32% of patients, typically within the first 48 h, and was more frequent in those supported with VA-ECMO.
CONCLUSION: In AMI-CS patients requiring ST-MCS, ischemic events were uncommon, whereas major bleeding was frequent and occurred early. These findings underscore the need for individualized antithrombotic strategies in this high-risk population.