Background: Percutaneous mechanical circulatory support (pMCS), such as intra-aortic balloon pump (IABP), percutaneous ventricular assist device (PVAD; Impella or Tandem Heart) or extracorporeal membrane oxygenation (ECMO), have emerged as an important tool in recent years for stabilising patients with STEMI and cardiogenic shock (STEMI-CS). Stroke is a devastating complication and there is a lack of data on its incidence in patients with pMCS.
Hypothesis: We hypothesise that the incidence of stroke will be higher among patients on pMCS.
Methods: All patients with STEMI-CS were selected from a large National Inpatient Sample database between 2005 and 2014. They were then divided into four groups: no MCS, IABP, PVAD or ECMO. The incidence and outcomes of both ischaemic and haemorrhagic stroke among these patients was determined. In-hospital mortality, length of stay and healthcare cost was compared among them.
Results: In total, 35,884 patients were included in the study, of whom 1,523 (4.2%) developed acute strokes of ischaemic (2.8%) and haemorrhagic (0.5%) aetiology. The incidence of stroke was higher among patients with pMCS: ECMO (9.9%), PVAD (6.4%), no MCS (4.3%) and IABP (4.0%). Stroke was associated with higher inpatient mortality (38.6% versus 29.8%, p<0.0001), length of stay (15 versus 9 days, p<0.0001) and healthcare cost ($215,989 versus $141,779, p<0.0001) in patients with STEMI-CS. The incidence of mortality secondary to a haemorrhagic stroke was higher compared to an ischaemic stroke (60.9% versus 37.2%). We also noted that patients with pMCS had more events than those without pMCS (54.9% versus 41.3%).
Conclusion: In patients on pMCS, the incidence of stroke was highest in patients on ECMO. Mortality was higher in patients with haemorrhagic stroke relative to ischaemic stroke, irrespective of pMCS. Considering the increasing cost and poor outcomes with pMCS, there is a need for further research to help determine the best strategies to prevent stroke in this patient population.