CHICAGO — Mechanical circulatory support leads to improved outcomes in patients with post-MI profound cardiogenic shock unresponsive to standard aggressive therapies, Nicolle Kramer, Ph.D., said at the annual meeting of the Society for Cardiovascular Angiography and Interventions.
She presented national registry data showing that temporary use of the Abiomed AB5000 extracorporeal ventricular assist device (VAD) resulted in an impressive survival rate in such patients. Moreover, native cardiac function was restored in two-thirds of survivors.
Recovery of native heart function should be considered the first option in these high-mortality patients, according to Dr. Kramer, a clinical applications engineer at Abiomed Inc., Danvers, Mass.
“This was not a selected best-practices group of patients,” she noted in an interview. “This study involved 26 centers and included everyone in the U.S. who received an AB5000 as a bridge-to-recovery device between October 2003 and July 2005.”
Despite considerable progress in the treatment of acute MI in recent years, cardiogenic shock continues to occur in 7% of cases. Mortality remains high—roughly 50%—despite the use of intraaortic balloon pumps, emergency revascularization, and inotropes, the current standard of care.
This was the impetus for the AB5000 bridge-to-recovery registry. It involved 50 patients in profound cardiogenic shock refractory to conventional measures. They averaged 31 hours in cardiogenic shock prior to device implantation; 24 of the 50 patients required biventricular support.
Hemodynamics immediately stabilized upon VAD implantation. (See box.)
Some 52% of patients died while on the VAD. But outcomes in patients who survived hospitalization were promising: 67% were discharged with recovery of native cardiac function, 29% underwent heart transplantation, and a single patient got a VAD as destination therapy. Recovery took an average of 32 days of support, she said.
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