Acute cardiac care & resuscitation
Door-to-unload time and mortality in patients with ST-segment elevation myocardial infarction complicated by cardiogenic shock
Main finding · In-hospital mortalityResult — go to the resultAdjusted odds ratio 1.56 95% CI 1.26–1.95Authors' conclusion
A shorter door-to-unload time, particularly within 90 min, is associated with better survival in patients with STEMI-CS.
Study context
- Population
- Consecutive patients with STEMI-CS who underwent mAFP placement between February 2020 and December 2023patients with STEMI-CS undergoing mAFP placement
- Participants
- 1,783 patients
- Exposure
- Delayed placement vs door-to-unload time within 90 min
- Outcome
- In-hospital mortality
Methodological detailsconsecutive patients, Japan Registry for Percutaneous Ventricular Assist Devices
- Consecutive patients
- Japan Registry for Percutaneous Ventricular Assist Devices
Main finding
In-hospital mortality
Adjusted odds ratio
1.56
95% CI 1.26–1.95
By group
Delayed placement (>90 min) vs within 90 min
adjusted odds ratio 1.56 (95% CI 1.26–1.95)
As reported in the abstract
- Overall in-hospital mortality rate
- 39.2%
Observational data: associations, not effects.
Further findings
Door-to-unload time
- Median door-to-unload time
- 99 min
Restricted cubic spline of mortality by door-to-unload time
- Mortality remained stable when placement was within 90 min, followed by an increase
Stratified by no prior mechanical circulatory support and prior venoarterial extracorporeal membrane oxygenation (VA-ECMO) only
- Patients with prior VA-ECMO only had more severe baseline characteristics and higher mortality; association of longer door-to-unload time with higher mortality was consistent
Predictors of delayed mAFP placement
- Older age, lower institutional volume, higher heart rate, higher creatinine levels, prior use of an intra-aortic balloon pump or VA-ECMO, and percutaneous coronary intervention before mAFP placement
Original publication
Door-to-unload time and mortality in patients with ST-segment elevation myocardial infarction complicated by cardiogenic shock. EuroIntervention. Published 15 June 2026. doi:10.
Summarised from the published abstract; every number is checked against it