PMID- 31041870 OWN - NLM STAT- MEDLINE DCOM- 20200803 LR - 20210908 IS - 2047-9980 (Electronic) IS - 2047-9980 (Linking) VI - 8 IP - 9 DP - 2019 May 7 TI - Prospective Comparison of a Percutaneous Ventricular Assist Device and Venoarterial Extracorporeal Membrane Oxygenation for Patients With Cardiogenic Shock Following Acute Myocardial Infarction. PG - e012171 LID - 10.1161/JAHA.119.012171 [doi] LID - e012171 AB - Background Cardiogenic shock ( CS ) following acute myocardial infarction ( AMI ) portends a poor prognosis. Both venoarterial extracorporeal membrane oxygenation ( VA - ECMO ) and a percutaneous ventricular assist device ( pVAD ) provide hemodynamic support for patients with CS, but little is known about the best device for this population. We sought to compare outcomes of AMI patients treated with these devices. Methods and Results Consecutive patients with CS following AMI from April 2015 to March 2017 were enrolled prospectively if they received either device for AMI -related CS . If patients received both devices, they were analyzed according to the first used. The primary outcome was all-cause mortality. In total, 51 patients received VA - ECMO or pVAD following AMI ; 20 received VA - ECMO, and 31 received pVAD . The mean age was 62.1+/-10.1 years, and 39 (76.5%) were men. Twenty-four (47.1%) patients were ultimately supported by both devices simultaneously (20 pVAD -first, 4 VA - ECMO -first). Patients treated with pVAD or VA - ECMO were similar in baseline characteristics at initial device insertion except that the latter were on more vasopressors and were more likely to have an intra-aortic balloon pump. Seventeen (33.3%) had recent cardiopulmonary resuscitation, mean lactate was 4.86+/-3.96 mmol/L, and mean cardiac index was 1.70+/-0.42 L/min per m(2). Of the 28 (54.9%) patients surviving to discharge, 11 had received VA - ECMO first and 17 had pVAD first ( P=0.99). Survival at 1 and 2 years did not differ significantly between device groups ( P=0.42). Conclusions Following AMI -related CS , pVAD - and VA - ECMO -treated patients had similar outcomes. The use of both devices simultaneously was common, with almost half of patients in persistent CS after first device deployment. FAU - Garan, A Reshad AU - Garan AR AD - 1 Division of Cardiology Department of Medicine Columbia University Medical Center New York NY. FAU - Takeda, Koji AU - Takeda K AD - 2 Department of Surgery Columbia University Medical Center New York NY. FAU - Salna, Michael AU - Salna M AD - 2 Department of Surgery Columbia University Medical Center New York NY. FAU - Vandenberge, John AU - Vandenberge J AD - 2 Department of Surgery Columbia University Medical Center New York NY. FAU - Doshi, Darshan AU - Doshi D AD - 3 Division of Cardiology Department of Medicine Massachusetts General Hospital Harvard Medical School Boston MA. FAU - Karmpaliotis, Dimitri AU - Karmpaliotis D AD - 1 Division of Cardiology Department of Medicine Columbia University Medical Center New York NY. FAU - Kirtane, Ajay J AU - Kirtane AJ AD - 1 Division of Cardiology Department of Medicine Columbia University Medical Center New York NY. FAU - Takayama, Hiroo AU - Takayama H AD - 2 Department of Surgery Columbia University Medical Center New York NY. FAU - Kurlansky, Paul AU - Kurlansky P AD - 2 Department of Surgery Columbia University Medical Center New York NY. LA - eng GR - KL2 TR001874/TR/NCATS NIH HHS/United States GR - UL1 TR001873/TR/NCATS NIH HHS/United States PT - Comparative Study PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PL - England TA - J Am Heart Assoc JT - Journal of the American Heart Association JID - 101580524 SB - IM MH - Aged MH - *Extracorporeal Membrane Oxygenation/adverse effects/mortality MH - Female MH - *Heart-Assist Devices MH - *Hemodynamics MH - Hospital Mortality MH - Humans MH - Male MH - Middle Aged MH - Myocardial Infarction/diagnosis/mortality/physiopathology/*therapy MH - Prospective Studies MH - Prosthesis Design MH - Recovery of Function MH - Risk Factors MH - Shock, Cardiogenic/diagnosis/mortality/physiopathology/*therapy MH - Time Factors MH - Treatment Outcome PMC - PMC6512118 OTO - NOTNLM OT - Impella OT - acute myocardial infarction OT - cardiogenic shock OT - extracorporeal membrane oxygenation OT - hemodynamics OT - percutaneous ventricular assist device EDAT- 2019/05/02 06:00 MHDA- 2020/08/04 06:00 PMCR- 2019/05/07 CRDT- 2019/05/02 06:00 PHST- 2019/05/02 06:00 [entrez] PHST- 2019/05/02 06:00 [pubmed] PHST- 2020/08/04 06:00 [medline] PHST- 2019/05/07 00:00 [pmc-release] AID - JAH34093 [pii] AID - 10.1161/JAHA.119.012171 [doi] PST - ppublish SO - J Am Heart Assoc. 2019 May 7;8(9):e012171. doi: 10.1161/JAHA.119.012171.