Abstract 4140006: Risk of Acute Ischemic Stroke with Early Versus Late Initiation of Mechanical Circulatory Support in Patients with Acute Myocardial Infarction Complicated by Cardiogenic Shock: A Propensity-Matched Analysis

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. Aims: This study aimed to assess the timing of MCS initiation associated with the risk of AIS in patients with AMI-CS. Methods: A retrospective of the National Inpatient Sample data analysis (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: From 2016 to 2020, the use of IABP decreased from 35.89% to 30.21%, whereas Impella use increased from 8.49% to 15.27% and ECMO use increased from 2.05% to 2.90% . The incidence of AIS in patients with AMI-CS receiving MCS remained stable over the study period; 3.55% in 2016 and 4.54% in 2020 (P trend = 0.277). Among 78,405 weighted patients with AMI-CS receiving MCS, 82.77% (n=64,895) and 17.23% (n=13,510) underwent early and late MCS initiation, respectively. The patients with late MCS initiation had higher risks of AIS (5.74% vs. 3.60%; adjusted odds ratio [aOR] 1.46; 95% confidence interval [CI], 1.19-1.79; p<0.001), AKI (61.73% vs. 50.40%; aOR, 1.41; 95%CI 1.27-1.55; p<0.001), and major bleeding (43.19% vs. 29.72%; aOR, 1.12; 95%CI 1.01-1.23; p=0.028). A propensity-matched cohort, adjusted for risk factors indicated that 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). Furthermore, subgroup analysis revealed that an AMI-CS hospitalization with late MCS was consistently associated with a high AIS risk among all subgroups. Conclusions: Among patients with AMI-CS, late initiation of MCS was associated with increased risks of AIS, AKI, and major bleeding. Further studies are needed to decipher the optimal timing of MCS initiation to improve outcomes in this critically ill population.