Mechanical Circulatory Support in Myocardial Infarction Complicated by Cardiogenic Shock: Impact of Sex and Timing

Background: Sex differences in presentation, treatment, and outcomes persist in patients with acute myocardial infarction complicated by cardiogenic shock (AMICS). Sex-based outcomes of patients with AMICS undergoing percutaneous coronary intervention (PCI) with percutaneous left ventricular assist device (pLVAD) support are poorly defined. Methods: From January 2017 to August 2019, consecutive patients undergoing PCI who received Impella support within 48 ​hours of myocardial infarction were enrolled in the prospective RECOVER III postmarket registry. In-hospital survival and predictors of mortality were compared by sex. Results: A total of 358 patients (276 men and 82 women) were included. Women had lower baseline mean arterial pressure and shorter duration of pLVAD support compared with men. In-hospital adverse events were similar in women and men, including mortality (54% versus 46%, P = .25), major bleeding (11% versus 10%, P = .83), and vascular complications requiring surgery (8.5% versus 4%, P = .10). Women had better survival with pre-PCI versus post-PCI pLVAD implantation (59% versus 34%, P = .03), whereas survival in men was similar regardless of pre- versus post-PCI pLVAD support (56% versus 50%, P = .39). The number of inotrope/vasopressor use pre-pLVAD was the strongest predictor of mortality in women (OR 3.03, P = .01) but not in men (OR 1.18, P = .25). Conclusions: Survival of patients with AMICS treated with PCI and Impella support was 52% at hospital discharge and was similar for women and men. Women with AMICS may derive greater benefit from early pLVAD support prior to escalation of inotrope/vasopressors and had no evidence of increased risk of access-related complications.