{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T13:31:20Z","timestamp":1786541480133,"version":"build-2736575974"},"posted":{"date-parts":[[2025,11,27]]},"group-title":"Cardiovascular Medicine","reference-count":28,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T00:00:00Z","timestamp":1764201600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"award":["FD005938"],"award-info":[{"award-number":["FD005938"]}],"id":[{"id":"https:\/\/ror.org\/05hvrsg85","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2025,11,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:p>Acute myocardial infarction complicated by cardiogenic shock (AMI-CS) is a heterogeneous clinical syndrome associated with substantial morbidity and mortality. We developed a machine learning-based mortality model to identify features and patient subgroups associated with the largest change in mortality risk when evaluating treatment with Impella devices or intra-aortic Balloon Pump (IABP). Our cohort comprised 369 sites and 15,796 patient visits to the cardiac catheterization laboratory from the National Cardiovascular Data Registry. The estimated population mean excess mortality effect of treatment with Impella devices vs IABP was 10.4 \u00b1 0.8%. However, we identified clinical subgroups of 282 patients for whom a decreased risk of mortality was associated with use of Impella as compared with IABP. Those patients were on average younger, presented with higher systolic blood pressure, higher rate of salvage percutaneous coronary intervention, higher initial creatinine, and lower hemoglobin. While Impella devices were associated with higher mortality risk overall, certain clinical profiles were associated with lower risk, illustrating heterogeneity of treatment effects.<\/jats:p>","DOI":"10.1101\/2025.11.24.25340896","type":"posted-content","created":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T21:50:13Z","timestamp":1764280213000},"source":"Crossref","is-referenced-by-count":0,"title":["Modeling In-Hospital Mortality Among Patients Undergoing Percutaneous Coronary Intervention with Acute Myocardial Infarction Complicated by Cardiogenic Shock Receiving Mechanical Circulatory Support"],"prefix":"10.64898","author":[{"given":"Nathan C.","family":"Hurley","sequence":"first","affiliation":[{"name":"Department of Computer Science and Engineering, Texas A&M University, College Station"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2655-2095","authenticated-orcid":false,"given":"Bobak J.","family":"Mortazavi","sequence":"additional","affiliation":[{"name":"Department of Computer Science and Engineering, Texas A&M University, College Station"},{"name":"Center for Remote Health Technologies and Systems, Texas A&M University, College Station"},{"name":"Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0674-2032","authenticated-orcid":false,"given":"Sanket S.","family":"Dhruva","sequence":"additional","affiliation":[{"name":"University of California, San Francisco School of Medicine, San Francisco"},{"name":"Section of Cardiology, Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9218-3320","authenticated-orcid":false,"given":"Joseph S.","family":"Ross","sequence":"additional","affiliation":[{"name":"Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut"},{"name":"Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut"},{"name":"Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Che G.","family":"Ngufor","sequence":"additional","affiliation":[{"name":"Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota"},{"name":"Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeptha P","family":"Curtis","sequence":"additional","affiliation":[{"name":"Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut"},{"name":"Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2046-127X","authenticated-orcid":false,"given":"Harlan M.","family":"Krumholz","sequence":"additional","affiliation":[{"name":"Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut"},{"name":"Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut"},{"name":"Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nihar R.","family":"Desai","sequence":"additional","affiliation":[{"name":"Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut"},{"name":"Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026081205402057000_2025.11.24.25340896v1.1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.0254"},{"key":"2026081205402057000_2025.11.24.25340896v1.2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.114.014451"},{"issue":"6","key":"2026081205402057000_2025.11.24.25340896v1.3","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1001\/jamainternmed.2014.7856","article-title":"Trends in the use of percutaneous ventricular assist devices: analysis of national inpatient sample data, 2007 through 2012","volume":"175","year":"2015","journal-title":"JAMA internal medicine"},{"key":"2026081205402057000_2025.11.24.25340896v1.4","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.114.001462"},{"key":"2026081205402057000_2025.11.24.25340896v1.5","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.28329"},{"issue":"9","key":"2026081205402057000_2025.11.24.25340896v1.6","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1016\/j.jacc.2022.01.018","article-title":"SCAI SHOCK Stage Classification Expert Consensus Update: A Review and Incorporation of Validation Studies: This statement was endorsed by the American College of Cardiology (ACC), American College of Emergency Physicians (ACEP), American Heart Association (AHA), European Society of Cardiology (ESC) Association for Acute Cardiovascular Care (ACVC), International Society for Heart and Lung Transplantation (ISHLT), Society of Critical Care Medicine (SCCM), and Society of Thoracic Surgeons (STS) in December 2021","volume":"79","year":"2022","journal-title":"Journal of the American College of Cardiology"},{"key":"2026081205402057000_2025.11.24.25340896v1.7","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.37748"},{"key":"2026081205402057000_2025.11.24.25340896v1.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.05.065"},{"key":"2026081205402057000_2025.11.24.25340896v1.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.10.022"},{"issue":"4","key":"2026081205402057000_2025.11.24.25340896v1.10","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1161\/CIRCULATIONAHA.119.044007","article-title":"The evolving landscape of Impella use in the United States among patients undergoing percutaneous coronary intervention with mechanical circulatory support","volume":"141","year":"2020","journal-title":"Circulation"},{"key":"2026081205402057000_2025.11.24.25340896v1.11","unstructured":"Kim Y , Shapero K , Ahn SS , Goldsweig AM , Desai N , Altin SE . 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