Contemporary use and outcomes of temporary mechanical circulatory support in patients undergoing percutaneous coronary intervention
O L Emilsson, M A Mohammad, S Zwackman, O Braun, F Bohm, T Ramunddal, S Volz, Liyew Desta, G Olivecrona, J Hollenberg, S KoulAbstract
Background
Temporary mechanical circulatory support (tMCS) is an important component in the management of cardiogenic shock and high-risk percutaneous coronary intervention (PCI). However, contemporary descriptive data on tMCS use in these settings are limited, despite the recent publications of potentially practice-changing randomised controlled trials, including DANGER-SHOCK and ECLS-SHOCK (1,2).
Purpose
To describe current patient characteristics and clinical outcomes associated with the use of tMCS, including intra-aortic balloon pumps (IABP), microaxial flow pumps, and veno-arterial extracorporeal membrane oxygenation (VA-ECMO), in patients undergoing PCI, without performing any comparative analysis between devices.
Methods
We included the first-time event of patients recorded in the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) undergoing PCI with support from IABP, VA-ECMO or microaxial flow pump between September 2019 and 27 August 2025. For patients admitted to a cardiac intensive care unit (CICU) during the admission, data were linked to the Register of Information and Knowledge about Swedish Heart Intensive Care Admissions (RIKS-HIA). Patient characteristics, procedural indications, timing of procedure, antithrombotic treatment, and outcomes were assessed separately for each tMCS.
Results
A total of 401 patients were included: 153 treated with IABP, 128 with VA-ECMO, and 120 with a microaxial flow pump. Median ages were 67, 62, and 70 years, respectively. ST-elevation myocardial infarction (STEMI) was the most common indication for PCI across groups (65% for IABP, 59% for VA-ECMO, and 44% for microaxial flow pump. Presentation with Killip class III or IV occurred in 63%, 71%, and 43% of patients in the respective groups. In the catheterisation laboratory, cangrelor was administered in 56% of IABP cases, 64% of VA-ECMO cases, and 32% of microaxial flow pump cases. Thirty-day mortality was 45% for IABP, 50% for VA-ECMO, and 24% for microaxial flow pump recipients, increasing to 58%, 63%, and 31% at one year. Among patients discharged alive from the CICU, one-year mortality was 7.4%, 7.0%, and 2.5%, respectively. Three procedure-related deaths were recorded: two in the IABP group and one in the microaxial flow pump group.
Conclusion
Use of tMCS in patients undergoing coronary PCI varied by device type and clinical presentation. tMCS were most frequently used in STEMI and commonly used in patients with cardiogenic shock (Killip class III or IV). VA-ECMO was regularly used in cardiac arrest. Despite high overall mortality, outcomes among surviving patients discharged from CICU were favourable.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.