Trends in Racial Disparities in Real World Outcomes of Patients with Temporary Mechanical Circulatory Support Following an Acute Myocardial Infarction
Authors: Ugoala Onyinye , Ebubechukwu Ugochukwu , Anuforo Anderson , Okeke Chukwuemelie , Tariq Hassan , Samad Ayesha , Chinnatambi Christopher , Shaikh Jairah , Bob-Manuel Tamunoinemi , Erwin John P , Dani Sourbha , Bailey Alison L 
Published: February 2025

Background

Data are limited regarding the association of race and outcomes for patients requiring temporary mechanical circulatory support (tMCS) after acute myocardial infarction (AMI).

Methods

Utilizing the TriNetX US collaborative network, we included adults with tMCS post-AMI from 01/2009-12/2023 and created two cohorts: non-Hispanic Black (NHB) and non-Hispanic White (NHW) participants. 1:1 Propensity score matching (PSM) was performed for age, sex, comorbid conditions, coronary artery procedures, and medications. Primary outcomes were bleeding or ischemic stroke within 7 days, 30 days, 90 days, and 1-year follow-up. Secondary outcomes included all-cause mortality, cardiac arrest, ventricular tachycardia (VT), ventricular fibrillation (VF), mechanical complications of AMI, intracardiac thrombus, severe sepsis, and acute kidney injury (AKI).

Results

Our study analyzed 2,808 patients in the NHB and 18,956 in the NHW cohorts. After PSM, both cohorts had 2,794 patients each. There was no statistically significant difference in bleeding risk across all timepoints when comparing NHB with NHW patients. However, NHB patients had statistically significant increased risk of ischemic stroke at 90 days (HR 1.28; 95% CI: 1.01-1.64) and 1 year (HR 1.43; 95% CI: 1.15-1.78). NHB patients also had a significantly increased risk of AKI at 7 days (HR 1.20; 95% CI: 1.06-1.36), 30 days (HR 1.20; 95% CI: 1.06-1.35), 90 days (HR 1.19; 95% CI: 1.06-1.34) and 1 year (HR 1.21; 95% CI: 1.08-1.36). NHB individuals also had an increased risk of all-cause mortality (HR 1.13; 95% CI: 1.03-1.24), cardiac arrest (HR 1.18; 95% CI: 1.04-1.34) and VF (HR 1.20; 95% CI: 1.02-1.41) at 1 year, but reduced risk of mechanical complications of AMI at 7 days (HR 0.47; 95% CI: 0.25-0.86), 30 days (HR 0.49; 95% CI: 0.28-0.84), 90 days (HR 0.52; 95% CI: 0.31-0.89) and 1 year (HR 0.48; 95% CI: 0.28-0.81). No significant differences were observed in other outcomes at each evaluated timepoint.

Conclusions

Compared to NHW patients requiring tMCS after AMI, NHB individuals had similar risk of bleeding but increased risk of ischemic stroke and cardiovascular events at longer term. For all follow-up times, NHB patients were more likely to develop AKI, but less likely to suffer from a mechanical complication of AMI.

Clinical Perspective

What is New?

This study highlights the presence of significant variations in immediate, short, and longer-term patient outcomes following placement of a temporary mechanical circulatory support (tMCS) device after acute myocardial infarction (AMI) in non-Hispanic Black (NHB) patients compared to non-Hispanic White (NHW) patients.

Relative to NHW patients, NHB patients had an increased risk of cardiovascular events at long term follow-up but had similar risk of bleeding. NHB patients were more likely to develop acute kidney injury (AKI) at each evaluated time period and had decreased all-cause survival at 1 year.

What are the Clinical Implications?

This study provides a framework that can be used in modifying treatment initiatives among underrepresented groups. Recognizing the distinctions in outcomes of tMCS procedures following AMI may help to ensure that personalized care can be developed and leveraged where indicated, in unique racial cohorts.