Trends and outcomes of different mechanical circulatory support modalities for refractory cardiogenic shock in Takotsubo cardiomyopathy
Background: The use of mechanical circulatory support (MCS) devices in cardiogenic shock is growing. We aim to study trends and compare different MCS modalities in this population. Methods: The National Readmission Database (2016-2020) was queried to identify TTC-CS requiring MCS. Cohorts were strat...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-06-01
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| Series: | American Heart Journal Plus |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666602225000485 |
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| author | Shafaqat Ali Manoj Kumar Yehya Khlidj Faryal Farooq Thannon Alsaeed Muhammad Sultan Pramod Kumar Ponna Laxman Byreddi Pratik Agrawal Vijaywant Brar Tarek Helmy Taher Tayeb |
| author_facet | Shafaqat Ali Manoj Kumar Yehya Khlidj Faryal Farooq Thannon Alsaeed Muhammad Sultan Pramod Kumar Ponna Laxman Byreddi Pratik Agrawal Vijaywant Brar Tarek Helmy Taher Tayeb |
| author_sort | Shafaqat Ali |
| collection | DOAJ |
| description | Background: The use of mechanical circulatory support (MCS) devices in cardiogenic shock is growing. We aim to study trends and compare different MCS modalities in this population. Methods: The National Readmission Database (2016-2020) was queried to identify TTC-CS requiring MCS. Cohorts were stratified as ECMO (extracorporeal membrane oxygenation) compared to other short-term percutaneous left ventricular assist devices (Impella). The propensity score matching (PSM) was used to remove confounders. Pearson’s x2 test was applied to PSM-matched cohorts to compare outcomes. Additionally, we used multivariate regression and reported predictive margins for adjusted trend analysis. Results: Among 2,025 TTC-CS hospitalizations requiring MCS, 1,790 required Impella vs. 235 on ECMO. ECMO was more common in metropolitan teaching hospitals (72.2 % vs 56.1 %, p < 0.05). On PSM cohorts (N = 131), ECMO had higher in-hospital mortality (38.9 % vs. 20.6 %, p < 0.001), major bleeding (15.3 % vs. 2.3 %, p < 0.001), acute blood loss anemia (48.9 % vs. 19.1 %, p < 0.001) among others. Our subgroup analysis comparing ECMO when Left ventricular (LV) unloading was provided by either IABP or Impella, and Impella alone showed no difference in the short-term mortality (42.2 % vs. 33.3 %, p: 0.384). However, the rates of major bleeding (17.8 % vs. 0.0 %, p: 0.003) and acute blood loss anemia (55.6 % vs. 22.2 %, p: 0.001) were higher for ECMO cohort. Conclusion: In the absence of LV unloading, the ECMO utilization in TTC-CS had higher mortality and adverse events than Impella. The mortality difference was nonsignificant when concomitant LV unloading was provided with Impella or IABP in these patients. |
| format | Article |
| id | doaj-art-370612ef754e4a09a4f9fc87e1f8e4d3 |
| institution | Kabale University |
| issn | 2666-6022 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Heart Journal Plus |
| spelling | doaj-art-370612ef754e4a09a4f9fc87e1f8e4d32025-08-20T03:48:47ZengElsevierAmerican Heart Journal Plus2666-60222025-06-015410054510.1016/j.ahjo.2025.100545Trends and outcomes of different mechanical circulatory support modalities for refractory cardiogenic shock in Takotsubo cardiomyopathyShafaqat Ali0Manoj Kumar1Yehya Khlidj2Faryal Farooq3Thannon Alsaeed4Muhammad Sultan5Pramod Kumar Ponna6Laxman Byreddi7Pratik Agrawal8Vijaywant Brar9Tarek Helmy10Taher Tayeb11Department of Internal Medicine, Louisiana State University, Shreveport, LA, USA; Corresponding author.Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USADepartment of Medicine, University of Algiers 1, Algiers, AlgeriaDepartment of Medicine, Allama Iqbal Medical College Lahore, PakistanDepartment of Internal Medicine, Louisiana State University, Shreveport, LA, USADepartment of Internal Medicine, Louisiana State University, Shreveport, LA, USADepartment of Internal Medicine, Louisiana State University, Shreveport, LA, USADepartment of Internal Medicine, Louisiana State University, Shreveport, LA, USADepartment of Cardiology, Louisiana State University, Shreveport, LA, USADepartment of Cardiology, Louisiana State University, Shreveport, LA, USADepartment of Cardiology, Louisiana State University, Shreveport, LA, USADepartment of Cardiology, Louisiana State University, Shreveport, LA, USABackground: The use of mechanical circulatory support (MCS) devices in cardiogenic shock is growing. We aim to study trends and compare different MCS modalities in this population. Methods: The National Readmission Database (2016-2020) was queried to identify TTC-CS requiring MCS. Cohorts were stratified as ECMO (extracorporeal membrane oxygenation) compared to other short-term percutaneous left ventricular assist devices (Impella). The propensity score matching (PSM) was used to remove confounders. Pearson’s x2 test was applied to PSM-matched cohorts to compare outcomes. Additionally, we used multivariate regression and reported predictive margins for adjusted trend analysis. Results: Among 2,025 TTC-CS hospitalizations requiring MCS, 1,790 required Impella vs. 235 on ECMO. ECMO was more common in metropolitan teaching hospitals (72.2 % vs 56.1 %, p < 0.05). On PSM cohorts (N = 131), ECMO had higher in-hospital mortality (38.9 % vs. 20.6 %, p < 0.001), major bleeding (15.3 % vs. 2.3 %, p < 0.001), acute blood loss anemia (48.9 % vs. 19.1 %, p < 0.001) among others. Our subgroup analysis comparing ECMO when Left ventricular (LV) unloading was provided by either IABP or Impella, and Impella alone showed no difference in the short-term mortality (42.2 % vs. 33.3 %, p: 0.384). However, the rates of major bleeding (17.8 % vs. 0.0 %, p: 0.003) and acute blood loss anemia (55.6 % vs. 22.2 %, p: 0.001) were higher for ECMO cohort. Conclusion: In the absence of LV unloading, the ECMO utilization in TTC-CS had higher mortality and adverse events than Impella. The mortality difference was nonsignificant when concomitant LV unloading was provided with Impella or IABP in these patients.http://www.sciencedirect.com/science/article/pii/S2666602225000485Takotsubo cardiomyopathyECMOImpellaMechanical circulatory supportCardiogenic shock |
| spellingShingle | Shafaqat Ali Manoj Kumar Yehya Khlidj Faryal Farooq Thannon Alsaeed Muhammad Sultan Pramod Kumar Ponna Laxman Byreddi Pratik Agrawal Vijaywant Brar Tarek Helmy Taher Tayeb Trends and outcomes of different mechanical circulatory support modalities for refractory cardiogenic shock in Takotsubo cardiomyopathy American Heart Journal Plus Takotsubo cardiomyopathy ECMO Impella Mechanical circulatory support Cardiogenic shock |
| title | Trends and outcomes of different mechanical circulatory support modalities for refractory cardiogenic shock in Takotsubo cardiomyopathy |
| title_full | Trends and outcomes of different mechanical circulatory support modalities for refractory cardiogenic shock in Takotsubo cardiomyopathy |
| title_fullStr | Trends and outcomes of different mechanical circulatory support modalities for refractory cardiogenic shock in Takotsubo cardiomyopathy |
| title_full_unstemmed | Trends and outcomes of different mechanical circulatory support modalities for refractory cardiogenic shock in Takotsubo cardiomyopathy |
| title_short | Trends and outcomes of different mechanical circulatory support modalities for refractory cardiogenic shock in Takotsubo cardiomyopathy |
| title_sort | trends and outcomes of different mechanical circulatory support modalities for refractory cardiogenic shock in takotsubo cardiomyopathy |
| topic | Takotsubo cardiomyopathy ECMO Impella Mechanical circulatory support Cardiogenic shock |
| url | http://www.sciencedirect.com/science/article/pii/S2666602225000485 |
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