Racial disparities in real-world outcomes of temporary mechanical circulatory support post-acute myocardial infarction

Racial disparities in outcomes for patients requiring temporary mechanical circulatory support (tMCS) after acute myocardial infarction (AMI) remain unclear. Therefore, we evaluated the racial disparities in patients requiring tMCS following AMI.

Using the TriNetX US collaborative network (2009–23), we identified non-Hispanic Black (NHB) and non-Hispanic White (NHW) adults who had AMI and required tMCS. Propensity score matching (PSM) was performed for age, sex, comorbid conditions, coronary artery procedures, and medications. Primary outcomes were bleeding or ischaemic stroke at 7days, 30 days, 90 days, and 1 year. 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). PSM included 2794 patients per cohort. NHB patients had an increased risk of ischaemic stroke at 90 days [hazard ratio (HR) 1.28; 95% confidence interval (CI): 1.01–1.64] and 1 year (HR 1.43; 95% CI: 1.15–1.78), along with an increased risk of AKI across all time. 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 a lower risk of mechanical complications of AMI across all time points. No significant differences were observed in the other outcomes assessed.

The NHB individuals requiring tMCS after AMI had a similar bleeding risk but higher rates of ischaemic stroke, AKI, and cardiovascular events at longer follow-ups, while experiencing fewer mechanical complications of AMI.