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Acute cardiac care & resuscitationCohort study

Door-to-unload time and mortality in patients with ST-segment elevation myocardial infarction complicated by cardiogenic shock

EuroInterventionPublished

  • Registry analysis
  • consecutive patients
  • Japan Registry for Percutaneous Ventricular Assist Devices
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Authors' 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

Main finding

As reported in the abstract

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)
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:10.4244/eij-d-25-01369
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Summarised from the published abstract; every number is checked against it