Availability of mechanical circulatory support (MCS) and hospital survival in ST-segment elevation myocardial infarction related cardiogenic shock (STEMI-CS)

BACKGROUND: In myocardial infarction-related cardiogenic shock, especially in the subgroup of ST-elevation myocardial infarction (STEMI-CS), mechanical circulatory support (MCS) might improve survival. If centers with MCS availability (MCS centers) have better outcome in STEMI-CS compared to those without MCS availability (non-MCS centers) is unknown. AIM: To analyze the association of the availability of MCS and prognosis in STEMI-CS. METHODS: Secondary analysis of the prospective "Feedback Intervention and Treatment Times in ST-segment Elevation Myocardial Infarction" (FITT-STEMI) registry comparing outcome in STEMI-CS treated in MCS and non-MCS centers. Primary endpoint was hospital mortality. RESULTS: Between 2013 and 2022, a total of 5604 patients with STEMI-CS at hospital admission were included (mean age 65.3 years, rate of primary percutaneous coronary intervention (PCI) 86.5%, hospital mortality 44.7%). Of these, 4340/5604 (77.4%) STEMI-CS were treated in MCS centers compared to 1264/5604 (22.6%) in non-MCS centers. Patients in MCS centers were younger (65.1 versus 66.0 years, respectively, p = 0.045), were less-frequently resuscitated in-hospital (31.4% versus 35.1%, respectively, p = 0.013), and had longer contact-to-balloon times (120.7 versus 114.6 minutes, respectively, p = 0.008). Hospital mortality was 44.7% in MCS centers compared to 45.0% in non-MCS centers (OR 0.985, 95%CI 0.869-1.118, p = 0.820). Results remained consistent after adjustment for time trends and center effects (OR 0.936, 95%CI 0.804-1.091, p = 0.397) and after stratification by SCAI shock stage at presentation. After propensity score matching, again hospital mortality was similar in MCS and non-MCS centers (45.8% versus 43.7%, OR 1.070, 95%CI 0.888-1.288, p = 0.478). CONCLUSION: In this large registry of patients with STEMI-CS, hospital survival did not differ between centers with and without MCS availability.