Risk of acute ischemic stroke with early versus late initiation of mechanical circulatory support in hospitalizations with acute myocardial infarction complicated by cardiogenic shock: a propensity-matched analysis
Abstract Background Mechanical circulatory support (MCS) devices have been widely used for managing acute myocardial infarction complicated by cardiogenic shock (AMI-CS). However, their use additionally elevates acute ischemic stroke (AIS) risk. There is insufficient data on the risk of AIS associat...
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BMC
2025-05-01
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| Series: | BMC Cardiovascular Disorders |
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| Online Access: | https://doi.org/10.1186/s12872-025-04810-9 |
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| author | Rui Yan Jie Yang Bo Shi Congyan Ye Shizhe Fu Kairu Wang Ru Yan Shaobin Jia Xueping Ma Guangzhi Cong |
| author_facet | Rui Yan Jie Yang Bo Shi Congyan Ye Shizhe Fu Kairu Wang Ru Yan Shaobin Jia Xueping Ma Guangzhi Cong |
| author_sort | Rui Yan |
| collection | DOAJ |
| description | Abstract Background Mechanical circulatory support (MCS) devices have been widely used for managing acute myocardial infarction complicated by cardiogenic shock (AMI-CS). However, their use additionally elevates acute ischemic stroke (AIS) risk. There is insufficient data on the risk of AIS associated with early versus late initiation of MCS in AMI-CS cases. Therefore, this study aimed to assess the timing of MCS initiation associated with the risk of AIS in hospitalizations with AMI-CS. Methods A retrospective data analysis of the National Inpatient Sample (January 2016–December 2020) identified AMI-CS hospitalizations: categorized into early MCS initiation (< 48 h) and late MCS initiation (> 48 h). The primary outcome was AIS; the secondary outcomes included in-hospital mortality, acute kidney injury (AKI), cardiac arrest, major bleeding, and blood transfusion. The outcomes were compared using logistic multivariate regression and 1:1 propensity score matching analyses between the groups. Results Among 78,405 weighted hospitalizations with AMI-CS receiving MCS, 82.77% (n = 64,895) and 17.23% (n = 13,510) underwent early and late MCS initiation, respectively. Hospitalizations with late MCS initiation had higher risks of AIS (adjusted odds ratio [aOR], 1.46; 95%confidence interval [CI], 1.19–1.79; p < 0.001), AKI (aOR, 1.41; 95%CI, 1.27–1.55; p < 0.001), and major bleeding (aOR, 1.12; 95%CI, 1.01–1.23; p = 0.028). After propensity score matching, late MCS initiation remained associated with increased risks of AIS (aOR, 1.39; 95%CI, 1.08–1.78; p = 0.010), AKI (aOR, 1.37; 95%CI, 1.23–1.53; p < 0.001), and major bleeding (aOR, 1.14; 95%CI, 1.02–1.28; p = 0.027). Conclusions Late initiation of MCS was associated with increased risks of AIS, AKI, and major bleeding. |
| format | Article |
| id | doaj-art-db2687b61936403784cbf2bf23e78874 |
| institution | Kabale University |
| issn | 1471-2261 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
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| series | BMC Cardiovascular Disorders |
| spelling | doaj-art-db2687b61936403784cbf2bf23e788742025-08-20T03:53:46ZengBMCBMC Cardiovascular Disorders1471-22612025-05-0125111010.1186/s12872-025-04810-9Risk of acute ischemic stroke with early versus late initiation of mechanical circulatory support in hospitalizations with acute myocardial infarction complicated by cardiogenic shock: a propensity-matched analysisRui Yan0Jie Yang1Bo Shi2Congyan Ye3Shizhe Fu4Kairu Wang5Ru Yan6Shaobin Jia7Xueping Ma8Guangzhi Cong9Institute of Medical Sciences, General Hospital of Ningxia Medical UniversityInstitute of Medical Sciences, General Hospital of Ningxia Medical UniversitySchool of Clinical Medicine, Ningxia Medical UniversitySchool of Clinical Medicine, Ningxia Medical UniversitySchool of Clinical Medicine, Ningxia Medical UniversitySchool of Clinical Medicine, Ningxia Medical UniversityInstitute of Medical Sciences, General Hospital of Ningxia Medical UniversityInstitute of Medical Sciences, General Hospital of Ningxia Medical UniversityInstitute of Medical Sciences, General Hospital of Ningxia Medical UniversityInstitute of Medical Sciences, General Hospital of Ningxia Medical UniversityAbstract Background Mechanical circulatory support (MCS) devices have been widely used for managing acute myocardial infarction complicated by cardiogenic shock (AMI-CS). However, their use additionally elevates acute ischemic stroke (AIS) risk. There is insufficient data on the risk of AIS associated with early versus late initiation of MCS in AMI-CS cases. Therefore, this study aimed to assess the timing of MCS initiation associated with the risk of AIS in hospitalizations with AMI-CS. Methods A retrospective data analysis of the National Inpatient Sample (January 2016–December 2020) identified AMI-CS hospitalizations: categorized into early MCS initiation (< 48 h) and late MCS initiation (> 48 h). The primary outcome was AIS; the secondary outcomes included in-hospital mortality, acute kidney injury (AKI), cardiac arrest, major bleeding, and blood transfusion. The outcomes were compared using logistic multivariate regression and 1:1 propensity score matching analyses between the groups. Results Among 78,405 weighted hospitalizations with AMI-CS receiving MCS, 82.77% (n = 64,895) and 17.23% (n = 13,510) underwent early and late MCS initiation, respectively. Hospitalizations with late MCS initiation had higher risks of AIS (adjusted odds ratio [aOR], 1.46; 95%confidence interval [CI], 1.19–1.79; p < 0.001), AKI (aOR, 1.41; 95%CI, 1.27–1.55; p < 0.001), and major bleeding (aOR, 1.12; 95%CI, 1.01–1.23; p = 0.028). After propensity score matching, late MCS initiation remained associated with increased risks of AIS (aOR, 1.39; 95%CI, 1.08–1.78; p = 0.010), AKI (aOR, 1.37; 95%CI, 1.23–1.53; p < 0.001), and major bleeding (aOR, 1.14; 95%CI, 1.02–1.28; p = 0.027). Conclusions Late initiation of MCS was associated with increased risks of AIS, AKI, and major bleeding.https://doi.org/10.1186/s12872-025-04810-9Acute ischemic strokeAcute myocardial infarctionCardiogenic shockMechanical circulatory supportPropensity score matching |
| spellingShingle | Rui Yan Jie Yang Bo Shi Congyan Ye Shizhe Fu Kairu Wang Ru Yan Shaobin Jia Xueping Ma Guangzhi Cong Risk of acute ischemic stroke with early versus late initiation of mechanical circulatory support in hospitalizations with acute myocardial infarction complicated by cardiogenic shock: a propensity-matched analysis BMC Cardiovascular Disorders Acute ischemic stroke Acute myocardial infarction Cardiogenic shock Mechanical circulatory support Propensity score matching |
| title | Risk of acute ischemic stroke with early versus late initiation of mechanical circulatory support in hospitalizations with acute myocardial infarction complicated by cardiogenic shock: a propensity-matched analysis |
| title_full | Risk of acute ischemic stroke with early versus late initiation of mechanical circulatory support in hospitalizations with acute myocardial infarction complicated by cardiogenic shock: a propensity-matched analysis |
| title_fullStr | Risk of acute ischemic stroke with early versus late initiation of mechanical circulatory support in hospitalizations with acute myocardial infarction complicated by cardiogenic shock: a propensity-matched analysis |
| title_full_unstemmed | Risk of acute ischemic stroke with early versus late initiation of mechanical circulatory support in hospitalizations with acute myocardial infarction complicated by cardiogenic shock: a propensity-matched analysis |
| title_short | Risk of acute ischemic stroke with early versus late initiation of mechanical circulatory support in hospitalizations with acute myocardial infarction complicated by cardiogenic shock: a propensity-matched analysis |
| title_sort | risk of acute ischemic stroke with early versus late initiation of mechanical circulatory support in hospitalizations with acute myocardial infarction complicated by cardiogenic shock a propensity matched analysis |
| topic | Acute ischemic stroke Acute myocardial infarction Cardiogenic shock Mechanical circulatory support Propensity score matching |
| url | https://doi.org/10.1186/s12872-025-04810-9 |
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