Risk of stroke for AMI treated with temporary mechanical circulatory support: ten-year data from National Inpatient Sample

Risk of stroke for AMI treated with temporary mechanical circulatory support: ten-year data from National Inpatient Sample | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Risk of stroke for AMI treated with temporary mechanical circulatory support: ten-year data from National Inpatient Sample Jing Wu, Chenguang Li, Zheng Xu, Baoguo Wang, Mingyou Zhang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4629600/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 14 Jul, 2025 Read the published version in Scientific Reports → Version 1 posted 14 You are reading this latest preprint version Abstract Objectives The aim of this study was to assess the risk of stroke for temporary mechanical circulatory support (tMCS) device treated acute myocardial infarction (AMI). Background Data are limited regarding risk of stroke for temporary mechanical circulatory support (tMCS) device treated acute myocardial infarction (AMI). Methods The national inpatient sample database was analyzed to identify adults who were hospitalized for AMI between 2012 and 2021, hospitalizations were grouped based on the temporary mechanical circulatory support device. Study design In the final cohort, there are 8,272,163 (96.0%) weighted hospitalizations treated without tMCS, 265,870 (3.1%) with Intra-Aortic Balloon Pump (IABP) alone, 59,240 (0.7%) with Impella alone, and 16,225 (0.2%) with Extracorporeal Membrane Oxygenation (ECMO) used during the hospitalization. Results The overall stroke rates for patients who treated without tMCS, IABP alone, Impella alone, and ECMO group were 3.41%, 3.46%, 4.51%, and 13.34% respectively. Specifically, the rates of ischemic stroke for these groups were 2.95%, 3.12%, 3.96% and 10.11% respectively. The rates for hemorrhagic stroke were 0.68%, 0.55%, 0.81%, and 4.90% for the same groups. In the stepwise forward Cox regression analysis, the adjusted OR (aOR) of ECMO use for overall stroke was 3.04 (95%CI [2.66-3.48]), followed by Impella only use with an aOR of 1.79 (95%CI [1.61-2.00]), and atrial fibrillation (aOR 1.34, 95%CI [1.31-1.38]). The subgroup analysis revealed that hospitalization with age younger than 50 years old, those without hypertension, and those presented with ST-elevation myocardial infarction are at particularly high risk of stroke for ECMO treated AMI. Conclusion This ten years AMI hospitalizations analysis revealed that ECMO and Impella treatment associated with increased risk of both ischemic and hemorrhagic stroke. Particularly for those younger than 50, those without hypertension, and those presented with ST-elevation myocardial infarction. However, treatment with IABP alone does not increase the risk of stroke. Health sciences/Cardiology Health sciences/Neurology Acute myocardial infarction stroke IABP Impella ECMO Figures Figure 1 Figure 2 Objectives The utilization of temporary mechanical circulatory support devices (tMCS) is a common strategy in managing cardiogenic shock complicated acute myocardial infarction (AMI). Intra-aortic balloon counterpulsation (IABP) is the most widely used tMCS [ 1 , 2 ], but impella and Extracorporeal membrane oxygenation (ECMO) are also being increasingly deployed. While AMI is known to increase the risk of both ischemic and hemorrhagic stroke[ 3 – 5 ]. There is limited data on the impact of tMCS device utilization on stroke risk. Therefore, our current study aims to bridge this gap by using the National Inpatient Sample (NIS) to investigate the following: 1) The rate of overall, ischemic, and hemorrhagic stroke for different tMCS devices in AMI hospitalizations, comparing them to those treated without tMCS devices. 2) Temporal trends in the incidence of overall, ischemic, and hemorrhagic stroke in AMI hospitalizations. 3) Predictor of overall, ischemic, and hemorrhagic stroke in AMI hospitalizations. 4) The risk of overall, ischemic, and hemorrhagic stroke for subgroup populations treated with different tMCS devices comparing them to those treated without tMCS. The results of this study will provide insights into the impact of tMCS device utilization on the risk of stroke in AMI patients. Methods Data source The data for this study is sourced from the 2012 to 2021 NIS database. The NIS database, developed by the Agency for Healthcare Research and Quality (HCUP) is the largest publicly available all-payer administrative claim-based database in the United States contains a 20% random sample of stratified inpatient hospitalization across the United States. discharge weight provided in the dataset is used to establish the national estimate for all U.S. hospitalizations. Study population In this study, we conducted a retrospective analysis of both STEMI and non-STEMI hospitalizations using data extracted from the NIS database. The hospitalizations were identified using international classification of diseases (ICD)-9th Revision and 10th Revision Clinical Modification codes, which are listed in the supplementary table 1 . The codes used to identify hospitalizations of acute ischemic stroke and hemorrhage stroke has been validated by prior studies[ 6 , 7 ]. Medical comorbidities were identified using the Elixhauser comorbidities refined for the ICD-9-CM and ICD-10-CM software tools. These tool helps identify and categorize various comorbidities present in the hospitalizations. The hospitalizations were then grouped based on the use of tMCS devices. The groups included: no tMCS use, the use of IABP only, the use of impella only, and the use of ECMO with or without other tMCS devices. Statistical Analysis Statistical analysis was conducted to compare categorical data using χ 2 tests of significance. While the Wilcoxon signed-rank test was employed to compare continuous data. 6 To assess the association between tMCS device utilization and the risk of ischemic and hemorrhagic stroke, univariate and multivariable Cox regression were performed. For the multivariable regression, stepwise forward Cox regression models were utilized to identify significant predictors, with an entry-level p value < 0.10. this approach aims to make statistical decisions regarding the inclusion or exclusion of the predictor solely based on their statistical significance, regardless of the underlying biophysiological mechanism. The variables included in the multivariable regression model were age, sex, race, hypertension, diabetes mellitus, obesity, smoking status, atrial fibrillation, prior stroke, prior PCI, prior myocardial infarction, prior coronary artery bypass grafting, chronic lung disease, peripheral arterial disease, family history of coronary artery disease, hypothyroidism, hospital size, hospital location and teaching status, primary insurance, IABP use only, impella use only, ECMO use. Cochran-Armitage test was utilized for the trend test. Subgroup analysis was conducted to report the odd ratio (OR) of overall, ischemic, and hemorrhagic stroke in each subgroup, the corresponding ORs and 95% confidence interval (CIs) are presented as forest plots. Statistical significance was defined as a 2-tailed p-value < 0.05. All analyses were performed using SAS 9.4 (SAS Institute, Cary, NC). Since the database used for the analysis was de-identified, institutional review board approval and informed consent were waived. All analyses were conducted in accordance with the HCUP data use agreement. The authors vouch for the accuracy and completeness of the data. Results Study flow chart and Hospitalization characteristics The study flow chart, depicted in Supplementary 1, illustrates the process of selecting hospitalizations for analysis. Initially, a total of 1,857,807 AMI hospitalizations were extracted from the 2012 to 2021 NIS database. After excluding 115,539 AMI hospitalizations with elective admission, 15,432 with COVID-19 infection, 2,058 with both IABP and Impella used but without ECMO, and 1,678 unspecified tMCS device usage, a final cohort of 1,723,100 hospitalizations were enrolled. After applying the discharge weight provided by the NIS database, the final cohort of the study included a total of 8,274,163 hospitalizations without tMCS treatment, 265,870 with IABP only, 59,240 with Impella only, and 16,225 with ECMO used during the hospitalization. A proportional Venn graph illustrating the proportion of hospitalizations with different modes of tMCS is presented in Supplementary Fig. 2. Table 1 presents the baseline characteristics of AMI hospitalization stratified by tMCS devices. In general, hospitalizations treated with tMCS are more likely to occur in large urban teaching hospitals. There are significant differences in management strategies, such as angiography, percutaneous coronary intervention, and coronary artery bypass grafting. The age of hospitalization treated with IABP only and Impella only is comparable to those treated with medical only, However, hospitalizations treated with ECMO are younger, tMCS device-treated hospitalizations are more likely to be male and presented with STEMI. They are also more likely to be diagnosed with cardiogenic shock and cardiac arrest, particularly for hospitalizations treated with ECMO. ECMO-treated hospitalizations have fewer comorbidities, such as hypertension, diabetes mellitus, chronic lung disease, hypothyroidism, and dementia. They are also less likely to have a history of smoking, MI, Prior coronary artery bypass surgery (CABG), and a prior history of stroke. Table 1 Baseline characteristics of AMI hospitalizations stratified by tMCS use Variables No tMCS N = 8,275,163 N = 4,370,069 IABP only N = 265,870 Impella only N = 59,240 ECMO N = 16,225 P Value Age 69 (59–80) 67 (58–75) 68 (60–77) 61 (52–68) < 0.001 Female 3,388,424 (40.96) 79,140 (29.77) 17,350 (29.29) 4,260 (26.26) < 0.001 STEMI 1,880,630 (22.73) 144,995 (55.54) 28,015 (47.29) 10,220 (62.99) < 0.001 Cardiac arrest 326,450 (3.95) 40,265 (15.14) 11,070 (18.69) 4,370 (26.93) < 0.001 Race < 0.001 white 5,849,834 (73.67) 185,240 (73.39) 40,885 (72.65) 10,110 (68.92) black 945,790 (11.91) 21,020 (8.33) 5,315 (9.44) 1,555 (10.60) Hispanic 656,375 (8.27) 23,590 (9.35) 5,310 (9.43) 1,340 (9.13) Asian/pacific islander 218,965 (2.76) 10,460 (4.14) 1,800 (3.20) 585 (3.99) Native American 43,635 (0.55) 1,445 (0.57) 505 (0.90) 110 (0.75) Other races 226,110 (2.85) 10,645 (4.22) 2,465 (4.38) 970 (6.61) Hypertension 6,329,439 (76.50) 193,360 (72.73) 43,575 (73.56) 9,240 (56.95) < 0.001 Diabetes mellitus 3,337,619 (40.34) 111,890 (42.08) 27,020 (45.61) 5,425 (33.44) < 0.001 Atrial fibrillation 1,824,910 (22.06) 69,560 (26.16) 14,470 (24.43) 3,955 (24.38) < 0.001 History of smoke 2,658,810 (32.13) 83,945 (31.57) 15,315 (25.85) 2,765 (17.04) < 0.001 Obesity 831,985 (19.04) 27,360 (20.12) 7,845 (18.88) 2,005 (18.75) < 0.001 Prior MI 671,160 (15.36) 18,120 (13.32) 6,110 (14.70) 750 (7.01) < 0.001 Prior PCI 734,670 (16.81) 17,850 (13.12) 5,705 (13.73) 1,415 (13.23) < 0.001 Prior CABG 457,540 (10.47) 6,430 (4.73) 2,825 (6.80) 535 (5.00) < 0.001 Prior stroke 369,415 (8.45) 7,805 (5.74) 2,785 (6.70) 330 (3.09) < 0.001 Peripheral arterial disease 505,595 (11.57) 17,110 (12.58) 6,820 (16.41) 1,760 (16.46) < 0.001 Chronic lung disease 1,052,425 (24.08) 26,405 (19.41) 8,250 (19.85) 1,425 (13.32) < 0.001 hypothyroidism 581,775 (13.31) 13,155 (9.67) 4,215 (10.14) 695 (6.50) < 0.001 Autoimmune conditions 136,665 (3.13) 3,055 (2.25) 990 (2.38) 190 (1.78) < 0.001 Dementia 336,825 (7.71) 3,145 (2.31) 1,325 (3.19) 70 (0.65) < 0.001 Hospital size (number of beds) < 0.001 Small 814,279 (18.63) 18,110 (13.32) 5,385 (12.96) 505 (4.72) Medium 1,326,219 (30.35) 39,830 (29.29) 11,705 (28.16) 1,485 (13.88) large 2,229,571 (51.02) 78,065 (57.40) 24,470 (58.88) 8,705 (81.39) Hospital location/teaching status < 0.001 Rural hospital 352,720 (8.07) 6,175 (4.54) 1,295 (3.12) 45 (0.42) Urban nonteaching 990,060 (22.66) 26,525 (19.50) 6,970 (16.77) 555 (5.19) Urban teaching 3,027,289 (69.27) 103,305 (75.76) 33,295 (80.11) 10,095 (94.39) Payer < 0.001 Medicare 2,687,599 (61.59) 74,935 (55.19) 25,000 (60.26) 4,110 (38.52) Medicaid 411,855 (9.44) 13,985 (10.30) 3,665 (8.83) 1,385 (12.98) Private 953,650 (21.85) 35,730 (26.32) 9,460 (22.80) 4,290 (40.21) Self-pay 178,515 (4.09) 6,610 (4.87) 2,040 (4.92) 480 (4.50) No charge 15,860 (0.36) 530 (0.39) 100 (0.24) 55 (0.52) Other 116,415 (2.67) 3,985 (2.94) 1,225 (2.95) 350 (3.28) Angiography 2,466,965 (56,45) 119,210 (87.65) 36,620 (88.11) 5,375 (50.26) < 0.001 PCI 1,588,700 (36.35) 66,375 (48.80) 33,675 (81.03) 3,910 (36.56) < 0.001 CABG 247,345 (5.66) 51,975 (38.22) 2,900 (6.98) 2,310 (21.60) < 0.001 Values n (%), or median (interquartile range). AMI: acute myocardial infarction; CABG: coronary artery bypass grafting; CAD: coronary artery disease; ECMO: extracorporeal membrane oxygenation; IABP: intra-aortic balloon pump; PCI: Percutaneous coronary intervention; STEMI: ST segment elevation myocardial infarction. Rate and trending of stroke in study groups Table 2 presents the rates of stroke for different treatment groups. The overall stroke rates for patients who treated without tMCS, IABP only, Impella only, and ECMO group were 3.41%, 3.46% 4.51%, and 13.34% respectively. Specifically, the rates of ischemic stroke for these groups were 2.95%, 3.12%, 3.96% and 10.11% respectively. The rates for hemorrhagic stroke were 0.68%, 0.55%, 0.81%, and 4.90% for the same groups. Table 2 also includes other in-hospital outcomes that were analyzed. Table 2 In-hospital outcomes in tMCS treated AMI hospitalizations stratified by tMCS use No tMCS N = 8,274,163 IABP only N = 265,870 Impella only N = 59,240 ECMO N = 16,225 P Value Stroke 282,275 (3.41) 9,210 (3.46) 2,670 (4.51) 2,165 (13.34) < 0.001 Ischemic stroke 244,200 (2.95) 8,305 (3.12) 2,345 (3.96) 1,640 (10.11) < 0.001 Hemorrhagic Stroke 56,420 (0.68) 1,450 (0.55) 480 (0.81) 795 (4.90) < 0.001 In-Hospital death 624,145 (7.54) 50,805 (19.11) 18,835 (31.79) 9,050 (55.78) < 0.001 Bleeding 718,525 (8.68) 43,785 (16.47) 10,655 (17.99) 5,210 (32.11) < 0.001 Acute kidney injury 2,140,390 (25.87) 100,795 (37.91) 29,945 (50.55) 12,000 (73.96) < 0.001 New dialysis 87,260 (1.71) 6,930 (4.34) 4,275 (8.34) 2,760 (21.57) < 0.001 Cardiac tamponade 10,065 (0.11) 2,510 (0.94) 745 (1.26) 840 (5.18) < 0.001 Acquired pneumonia 416,060 (5.03) 14,615 (5.50) 2,510 (4.24) 1,610 (9.92) < 0.001 Sepsis 792,100 (9.57) 22,985 (8.65) 7,085 (11.96) 3,685 (22.71) < 0.001 Tracheostomy 52,410 (0.63) 6,870 (2.58) 1,410 (2.38) 1,695 (10.45) < 0.001 Discharge status Routine 4,485,314 (54.21) 84,865 (31.92) 16,985 (28.67) 1,080 (6.66) < 0.001 Home health care 1,081,050 (13.07) 46,230 (17.39) 7,305 (12.33) 940 (5.79) < 0.001 Other care facility 1,980,665 (23.94) 82,865 (31.17) 15,885 (26.82) 5,135 (31.65) < 0.001 Length of stay, days 3 (2–7) 7 (4–12) 7 (3–12) 11 (4–24) < 0.001 Mean cost, $ 15,636 (9,001–25,382) 42,498 (26,584 − 65,193) 64,304 (46,380 − 90,782) 124,695 (69,202–221,595) < 0.001 Values n (%), or median (interquartile range). AMI: acute myocardial infarction; CABG: coronary artery bypass grafting; CAD: coronary artery disease; ECMO: extracorporeal membrane oxygenation; IABP: intra-aortic balloon pump; PCI: Percutaneous coronary intervention; STEMI: ST segment elevation myocardial infarction; tMCS: temporary mechanical circulatory support The quarterly rates of overall stroke, ischemic stroke, and hemorrhagic stroke for each group are reported in Fig. 1 . There has been an increasing trend of overall stroke and ischemic stroke in the Impella used only group. In contrast, the rates have remained stable in the other groups throughout the study period. Furthermore, the remarkably high risk of stroke associated with ECMO treatment is consistent across the entire study period. This consistency is observed in the rates of overall stroke, ischemic stroke, and hemorrhagic stroke. Predictor of stroke In the univariate Cox regression analysis, it was found that the use of ECMO was a major predictor of overall stroke, with an odds ratio (OR) of 4.25 and a 95% confidence interval (CI) of 3.75 to 4.83. This was followed by ages older than 75 years compared to ages younger than 50, with an OR of 1.62 and a 95% CI of 1.54 to1.69. Other significant predictors included atrial fibrillation (OR 1.59, 95% CI [1.56–1.63]), female sex (OR 1.41, 95%CI [1.38–1.44]), use of Impella (OR 1.35, 95%CI [1.21–1.49]), and prior history of stroke (OR 1.32, 95%CI [1.28–1.38]). In the stepwise forward Cox regression analysis, after adjusting for other variables the adjusted OR (aOR) of ECMO use for overall stroke was 3.04 (95%CI [2.66–3.48]), this was followed by Impella use with an aOR of 1.79 (95%CI [1.61-2.00]), and atrial fibrillation (aOR 1.34, 95%CI [1.31–1.38]). However, the use of IABP was not found to be associated with an increased risk of stroke in both univariate and multivariate regressions, as shown in Table 3 . For further details on the univariate and stepwise forward selection multivariate regression for ischemic stroke and hemorrhagic stroke, please refer to supplementary tables 2 and 3 respectively. Table 3 Univariate and multivariate regression for the risk of overall stroke Univariate regression Multivariate regression Variables OR Lower CI Upper CI p value aOR Lower CI Upper CI p value ECMO 4.25 3.75 4.83 < 0.001 3.04 2.66 3.48 75 Vs age < 50 1.62 1.54 1.69 < 0.001 1.21 1.15 1.27 < 0.001 Atrial fibrillation 1.59 1.56 1.63 < 0.001 1.34 1.31 1.38 < 0.001 Female 1.41 1.38 1.44 < 0.001 1.23 1.2 1.26 < 0.001 Impella only 1.35 1.21 1.49 < 0.001 1.79 1.61 2.00 < 0.001 Prior stroke 1.32 1.28 1.38 < 0.001 1.28 1.24 1.33 < 0.001 50 ≤ AGE ≤ 75 Vs age < 50 1.25 1.20 1.30 < 0.001 1.13 1.07 1.18 < 0.001 peripheral vascular disease 1.24 1.20 1.28 < 0.001 1.22 1.18 1.26 < 0.001 IABP only 1.04 0.98 1.11 0.22 0.94 0.87 1.00 0.06 Medicaid vs Medicare 1.01 0.98 1.05 < 0.001 1.12 1.07 1.16 < 0.001 Hypertension 0.99 0.97 1.02 0.61 1.07 1.04 1.10 < 0.001 Diabetes mellitus 0.96 0.94 0.98 < 0.001 0.95 0.93 0.97 < 0.001 Hypothyroidism 0.94 0.91 0.97 < 0.001 0.83 0.80 0.86 < 0.001 Chronic lung disease 0.80 0.78 0.82 < 0.001 0.72 0.70 0.74 < 0.001 White race 0.75 0.73 0.77 < 0.001 0.80 0.78 0.82 < 0.001 Small bedsize of hospital/Large bedsize of hospital 0.72 0.70 0.75 < 0.001 0.64 0.62 0.66 < 0.001 Rural/Urban teaching 0.72 0.70 0.74 < 0.001 0.58 0.55 0.61 < 0.001 Prior CABG 0.70 0.57 0.73 < 0.001 0.72 0.69 0.76 < 0.001 Rural/urban nonteaching 0.67 0.64 0.70 < 0.001 0.84 0.79 0.89 < 0.001 Obesity 0.66 0.64 0.68 < 0.001 0.72 0.70 0.74 < 0.001 Smoke 0.65 0.63 0.67 < 0.001 0.74 0.72 0.76 < 0.001 Private insurance vs Medicare 0.64 0.62 0.66 < 0.001 0.85 0.82 0.88 < 0.001 Prior MI 0.64 0.61 0.66 0.001 0.77 0.74 0.80 < 0.001 Prior PCI 0.60 0.54 0.58 < 0.001 0.65 0.63 0.68 < 0.001 Family history of CAD 0.38 0.36 0.40 < 0.001 0.48 0.46 0.51 < 0.001 PCI 0.27 0.26 0.28 < 0.001 0.29 0.28 0.30 < 0.001 CABG: coronary artery bypass grafting; CAD: coronary artery disease; ECMO: extracorporeal membrane oxygenation; IABP: intra-aortic balloon pump; PCI: Percutaneous coronary intervention; STEMI: ST segment elevation myocardial infarction; tMCS: temporary mechanical circulatory support. Subgroup analysis The findings above indicate a clear association between the use of ECMO and a significantly increased risk of overall, ischemic, and hemorrhagic stroke. Subgroup analysis was performed to assess the risk of stroke in specific subgroups, including gender, age, race, hypertension, diabetic mellitus, atrial fibrillation, as well as STEMI presentations. The analysis revealed that hospitalization with age younger than 50 years old, those without hypertension, and those presented with STEMI are at particularly high risk of stroke, as shown in Fig. 2 (p for interaction < 0.001 for all). Subgroup analysis to assess the risk of overall stroke for IABP and Impella is shown in Supplementary Figure S3 and S4 respectively, Subgroup analysis to assess the risk of ischemic and hemorrhagic stroke for different tMCS treated AMI is shown in Supplementary Figure S5-10. Discussion The use of tMCS for patients with cardiogenic shock complicated AMI has increased dramatically despite lacking convincing evidence showing the clinical benefits [ 8 , 9 ]. Moreover, the risk of stroke associated with tMCS devices has rarely been investigated. To our knowledge, this is the first large sample study with robust analysis to investigate the risk of stroke for different models of tMCS devices used in AMI hospitalizations. The main finding are as follows: 1) IABP use alone does not increase the risk of overall, ischemic, and hemorrhagic stroke; 2) Impella use alone slightly increase the risk of overall, ischemic, and hemorrhagic stroke; 3) ECMO use associated with remarkably high risk of overall, ischemic, and hemorrhagic stroke; 4) hospitalizations younger than 50 years old, those without hypertension, and those with STEMI are at particularly high risk of stroke when treated with ECMO. IABP continues to be the primary choice for tMCS during hospitalization for AMI. Despite uncertainties surrounding the survival advantages of IABP. [ 10 , 11 ], it is somewhat reassuring that there is no indication of increased risk of stroke associated with its use. The utilization of Impella has seen a significant rise, particularly following the IABP-SHOCK II trial [ 10 , 11 ]. The publication of DanGer Shock[ 12 ] result will undoubtably further encourage clinician to deploy impella for the mechanical circulatory support in cardiogenic shock complicated AMI. The rate of stroke in impella treated group are 3.9% compared to 2.3% in standard care group[ 12 ]. Consistent to these findings, this large sample analysis reports an increased risk of stroke for the Impella treated AMI. and trending for more ischemic and hemorrhagic cerebral event. The impella device have a larger profile and necessitate the use of larger caliber catheters for implantation, which inevitability increases the risk of vascular complications. In addition, the implantation of the Impella device requires crossing the aortic arch and aortic valve, which may contribute to more stroke events. Another potential reason for the increased occurrence of stroke with Impella could be attributed to hemodynamic changes. Unlike IABP, which augment the pulsatile blood flow, the continuous flow generated by Impella can lead to alterations in blood flow patterns, these abnormal flow pattern can create areas of stasis or turbulent flow, promoting the formation of blood clots thereby contributing to the increased risk of stroke. Data are scarce regarding the utilization of ECMO in cases of cardiogenic shock complicated AMI [ 13 – 16 ]. Recent ECLS-ECMO trial[ 17 ] found that early routine ECMO was not superior to usual medical therapy alone in terms of mortality within 30 days. prior studies showed, the use of ECMO has been associated with a significantly increased risk of stroke[ 13 , 18 ], with ischemic stroke being the most common type[ 19 ]. An analysis of 153 patients with VA-ECMO reported 8.4% acute ischemic stroke and 3.9% hemorrhagic stroke[ 20 ], which are comparable with the rates of stroke reported by our study. The mechanisms through which ECMO use contributes to an increased risk of stroke are multifactorial. Firstly, similar to the altered blood flow pattern caused by Impella, continuous blood flow from ECMO can increase the chance of thrombosis. Secondly, the presence of foreign surfaces like gas exchange membranes and hollow fibers in the ECMO oxygenator can activate the coagulation cascade, leading to an increased risk of clot formation. Additionally, blood flow through the oxygenator may result in the destruction of red blood cells causing hemolysis. Even at a low level, hemolysis during ECMO support could potentially raise the risk of stroke[ 21 ]. lastly, when VA-ECMO peripheral cannulation causes the retrograde flow to the proximal aorta, it significantly increases the afterload on the left ventricle. This, in turn, can lead to left ventricular distension, blood flow stagnation, and the formation of thrombi within the left ventricle[ 15 ]. Furthermore, the use of anticoagulant medications, which are often essential to prevent clotting in patients with Impella and ECMO devices, can also increase the risk of hemorrhagic stroke, balancing the need for anticoagulation to prevent clotting with the risk of bleeding complication is challenging in managing patients treated with Impella and ECMO. Given the potential severity of the stroke and its impact on patient outcomes, it is crucial that further research be conducted to better understand the risk factors, and prevention strategies associated with stroke in patients with Impella and ECMO use. In addition, advances in device technology should focus on minimizing the risk of stroke, this could involve the development of more biocompatible materials that reduce the formation of blood clots, as well as improving flow dynamic patterns. Additionally, optimizing anticoagulation protocols and monitoring strategies could help strike a balance between preventing clotting and minimizing bleeding complications. Limitations The present study had several limitations that should be noted. The administrative database lacked clinical details, such as hemodynamic, metabolite, medication, biochemistry, and imaging data, and there were no long-term follow-up data in the NIS dataset. Coding errors and underreporting of secondary diagnoses were also potential sources of bias. Additionally, as with all retrospective observational studies, even with robust confounder adjustment, residue confounding was inherent. The indications for ECMO, IABP, and Impella may vary between hospitals; therefore, selection bias was inevitable. Moreover, more granular data about the severity of stroke and Rankin Scales were not available. However, the NIS database has been extensively validated in previous publications[ 22 , 23 ]. This study included the largest sample of hospitalization comparing the rate of overall, ischemic, and hemorrhagic stroke, robust analyses were performed by multivariable regression and subgroup analysis. Conclusion This study investigating the rates, trends, and predictors of stroke in AMI hospitalizations treated with different tMCS devices. IABP use alone does not increase the risk of overall, ischemic, and hemorrhagic stroke. However, Impella and ECMO use associated with significant high risk of risk of overall, ischemic, and hemorrhagic stroke, particularly with the ECMO treatment. Further studies are warranted to illustrate the mechanism and to explore the strategies to reduce the risk of stroke. Declarations Competing Interests The authors have no competing interests to declare that are relevant to the content of this article. Funding This work was funded by the Health Technology Capability Enhancement Project of Jilin Province (2022JC054), the Scientific and Technological Developing Plan of Jilin Province (YDZJ202401287ZYTS, YDZJ202201ZYTS098), the Science and Technology Research of Jilin Provincial Department of Education (JJKH20231213KJ). Human Ethics and Consent to Participate declarations: not applicable. Acknowledgements: None. Data availability The study data can be accessed from the website ( https://www.hcup-us.ahrq.gov/ ) under appropriate data use agreements. 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Ferrante G, Rao SV, Jüni P, Da Costa BR, Reimers B, Condorelli G, Anzuini A, Jolly SS, Bertrand OF, Krucoff MW: Radial versus femoral access for coronary interventions across the entire spectrum of patients with coronary artery disease: a meta-analysis of randomized trials. JACC: Cardiovascular Interventions 2016, 9(14):1419–1434. Graipe A, Binsell-Gerdin E, Söderström L, Mooe T: Incidence, Time Trends, and Predictors of Intracranial Hemorrhage During Long-Term Follow-up After Acute Myocardial Infarction. J Am Heart Assoc 2015, 4(12). Columbo JA, Kang R, Trooboff SW, Jahn KS, Martinez CJ, Moore KO, Austin AM, Morden NE, Brooks CG, Skinner JS et al : Validating Publicly Available Crosswalks for Translating ICD-9 to ICD-10 Diagnosis Codes for Cardiovascular Outcomes Research. Circ Cardiovasc Qual Outcomes 2018, 11(10):e004782. Zachrison KS, Li S, Reeves MJ, Adeoye O, Camargo CA, Schwamm LH, Hsia RY: Strategy for reliable identification of ischaemic stroke, thrombolytics and thrombectomy in large administrative databases. Stroke Vasc Neurol 2021, 6(2):194–200. Stretch R, Sauer CM, Yuh DD, Bonde P: National Trends in the Utilization of Short-Term Mechanical Circulatory Support: Incidence, Outcomes, and Cost Analysis. Journal of the American College of Cardiology 2014, 64(14):1407–1415. Geller BJ, Sinha SS, Kapur NK, Bakitas M, Balsam LB, Chikwe J, Klein DG, Kochar A, Masri SC, Sims DB et al : Escalating and De-escalating Temporary Mechanical Circulatory Support in Cardiogenic Shock: A Scientific Statement From the American Heart Association. Circulation 2022, 146(6):e50-e68. Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, Richardt G, Hennersdorf M, Empen K, Fuernau G et al : Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 2012, 367(14):1287–1296. Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, de Waha A, Richardt G, Hennersdorf M, Empen K et al : Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial. Lancet 2013, 382(9905):1638–1645. Møller JE, Engstrøm T, Jensen LO, Eiskjær H, Mangner N, Polzin A, Schulze PC, Skurk C, Nordbeck P, Clemmensen P et al : Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock. New England Journal of Medicine 2024, 390(15):1382–1393. Ostadal P, Rokyta R, Karasek J, Kruger A, Vondrakova D, Janotka M, Naar J, Smalcova J, Hubatova M, Hromadka M et al : Extracorporeal Membrane Oxygenation in the Therapy of Cardiogenic Shock: Results of the ECMO-CS Randomized Clinical Trial. Circulation 2023, 147(6):454–464. Brunner S, Guenther SPW, Lackermair K, Peterss S, Orban M, Boulesteix AL, Michel S, Hausleiter J, Massberg S, Hagl C: Extracorporeal Life Support in Cardiogenic Shock Complicating Acute Myocardial Infarction. J Am Coll Cardiol 2019, 73(18):2355–2357. Ouweneel DM, Schotborgh JV, Limpens J, Sjauw KD, Engström AE, Lagrand WK, Cherpanath TGV, Driessen AHG, de Mol B, Henriques JPS: Extracorporeal life support during cardiac arrest and cardiogenic shock: a systematic review and meta-analysis. Intensive Care Med 2016, 42(12):1922–1934. Banning AS, Sabaté M, Orban M, Gracey J, López-Sobrino T, Massberg S, Kastrati A, Bogaerts K, Adriaenssens T, Berry C et al : Venoarterial extracorporeal membrane oxygenation or standard care in patients with cardiogenic shock complicating acute myocardial infarction: the multicentre, randomised EURO SHOCK trial. EuroIntervention 2023, 19(6):482–492. Thiele H, Zeymer U, Akin I, Behnes M, Rassaf T, Mahabadi AA, Lehmann R, Eitel I, Graf T, Seidler T et al : Extracorporeal Life Support in Infarct-Related Cardiogenic Shock. New England Journal of Medicine 2023, 389(14):1286–1297. Nishikawa M, Willey J, Takayama H, Kaku Y, Ning Y, Kurlansky PA, Brodie D, Masoumi A, Fried J, Takeda K: Stroke patterns and cannulation strategy during veno-arterial extracorporeal membrane support. J Artif Organs 2022, 25(3):231–237. Le Guennec L, Cholet C, Huang F, Schmidt M, Bréchot N, Hékimian G, Besset S, Lebreton G, Nieszkowska A, Leprince P et al : Ischemic and hemorrhagic brain injury during venoarterial-extracorporeal membrane oxygenation. Ann Intensive Care 2018, 8(1):129. Prokupets R, Kannapadi N, Chang H, Caturegli G, Bush EL, Kim BS, Keller S, Geocadin RG, Whitman GJR, Cho SM: Management of Anticoagulation Therapy in ECMO-Associated Ischemic Stroke and Intracranial Hemorrhage. Innovations (Phila) 2023, 18(1):49–57. Saeed O, Jakobleff WA, Forest SJ, Chinnadurai T, Mellas N, Rangasamy S, Xia Y, Madan S, Acharya P, Algodi M et al : Hemolysis and Nonhemorrhagic Stroke During Venoarterial Extracorporeal Membrane Oxygenation. Ann Thorac Surg 2019, 108(3):756–763. Elgendy IY, Gad MM, Mahmoud AN, Keeley EC, Pepine CJ: Acute Stroke During Pregnancy and Puerperium. J Am Coll Cardiol 2020, 75(2):180–190. Wu J, Fan Y, Zhao W, Li B, Pan N, Lou Z, Zhang M: In-Hospital Outcomes of Acute Myocardial Infarction With Essential Thrombocythemia and Polycythemia Vera: Insights From the National Inpatient Sample. J Am Heart Assoc 2022, 11(24):e027352. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4629600","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":328881716,"identity":"8afa1f90-b695-4b59-9aca-736631980682","order_by":0,"name":"Jing Wu","email":"","orcid":"","institution":"The First Hospital of Jilin University","correspondingAuthor":false,"prefix":"","firstName":"Jing","middleName":"","lastName":"Wu","suffix":""},{"id":328881717,"identity":"b736151b-3d2a-4664-8a0d-a7090cbc86da","order_by":1,"name":"Chenguang Li","email":"","orcid":"","institution":"Zhongshan Hospital","correspondingAuthor":false,"prefix":"","firstName":"Chenguang","middleName":"","lastName":"Li","suffix":""},{"id":328881718,"identity":"3cdb0f47-5532-4309-83ca-3bc202fb7860","order_by":2,"name":"Zheng Xu","email":"","orcid":"","institution":"The First Hospital of Jilin University","correspondingAuthor":false,"prefix":"","firstName":"Zheng","middleName":"","lastName":"Xu","suffix":""},{"id":328881719,"identity":"cd7a7552-6ca3-4c2c-b591-ceaf072c3c4d","order_by":3,"name":"Baoguo Wang","email":"","orcid":"","institution":"The First Hospital of Jilin University","correspondingAuthor":false,"prefix":"","firstName":"Baoguo","middleName":"","lastName":"Wang","suffix":""},{"id":328881720,"identity":"cb5e7076-4a50-41c7-a6ed-3eb715082253","order_by":4,"name":"Mingyou Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAArElEQVRIiWNgGAWjYHACxgcSBSA6gXgtzAYSBiRqYZNgIEmL/LQzZhUWBocZ+NlzDBh+7iBCC+PsHLMbEkAtkj1vDBh7zxChhVkaqsXgRo4BM2MbEVrYgFoKQFrsidbCA9TCALZFglgtEtJpxRISBuk8EmeeFRzsJUaL/OzkjZ8lKqzl+NuTNz74SYwWBgYOA2YJoANBzANEaWBgYH/A+IFIpaNgFIyCUTBCAQDbNyxxk3VWCwAAAABJRU5ErkJggg==","orcid":"","institution":"The First Hospital of Jilin University","correspondingAuthor":true,"prefix":"","firstName":"Mingyou","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2024-06-24 10:48:34","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4629600/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4629600/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-10555-4","type":"published","date":"2025-07-14T15:57:36+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":61005650,"identity":"272ffec5-dff2-4795-81b7-48a90e46c46e","added_by":"auto","created_at":"2024-07-24 13:46:05","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":185108,"visible":true,"origin":"","legend":"\u003cp\u003eAnnual rate of overall, ischemic, and hemorrhagic stroke. ECMO: extracorporeal membrane oxygenation; IABP: intra-aortic balloon pump.\u003c/p\u003e","description":"","filename":"Figure1annualrate.png","url":"https://assets-eu.researchsquare.com/files/rs-4629600/v1/450cf49948392152c0f7e460.png"},{"id":61005649,"identity":"632cde38-5e19-44bd-9566-98bdf815f63c","added_by":"auto","created_at":"2024-07-24 13:46:05","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":294072,"visible":true,"origin":"","legend":"\u003cp\u003eForest plot for subgroup analysis of overall stroke risk treated with ECMO to those without tMCS.\u003c/p\u003e\n\u003cp\u003eECMO: extracorporeal membrane oxygenation; OR: odds ratio; STEMI: ST segment elevation myocardial infarction; tMCS temporal mechanical circulatory support.\u003c/p\u003e","description":"","filename":"Figure2ecmoforest.png","url":"https://assets-eu.researchsquare.com/files/rs-4629600/v1/dc5589ab5cefdbf86eba248c.png"},{"id":87219814,"identity":"1a7c4827-7822-4aee-8b66-258c68af7e22","added_by":"auto","created_at":"2025-07-21 16:05:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1387018,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4629600/v1/c36af5b4-af41-4281-b790-4fc13133b8c0.pdf"},{"id":61005652,"identity":"c242a16f-9d27-45b5-b03d-d952831e1e01","added_by":"auto","created_at":"2024-07-24 13:46:05","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":13920607,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementalTablesANDFigures.docx","url":"https://assets-eu.researchsquare.com/files/rs-4629600/v1/8ee7015be4ed612b7866dae0.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Risk of stroke for AMI treated with temporary mechanical circulatory support: ten-year data from National Inpatient Sample","fulltext":[{"header":"Objectives","content":"\u003cp\u003eThe utilization of temporary mechanical circulatory support devices (tMCS) is a common strategy in managing cardiogenic shock complicated acute myocardial infarction (AMI). Intra-aortic balloon counterpulsation (IABP) is the most widely used tMCS [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], but impella and Extracorporeal membrane oxygenation (ECMO) are also being increasingly deployed.\u003c/p\u003e \u003cp\u003eWhile AMI is known to increase the risk of both ischemic and hemorrhagic stroke[\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. There is limited data on the impact of tMCS device utilization on stroke risk. Therefore, our current study aims to bridge this gap by using the National Inpatient Sample (NIS) to investigate the following: 1) The rate of overall, ischemic, and hemorrhagic stroke for different tMCS devices in AMI hospitalizations, comparing them to those treated without tMCS devices. 2) Temporal trends in the incidence of overall, ischemic, and hemorrhagic stroke in AMI hospitalizations. 3) Predictor of overall, ischemic, and hemorrhagic stroke in AMI hospitalizations. 4) The risk of overall, ischemic, and hemorrhagic stroke for subgroup populations treated with different tMCS devices comparing them to those treated without tMCS.\u003c/p\u003e \u003cp\u003eThe results of this study will provide insights into the impact of tMCS device utilization on the risk of stroke in AMI patients.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData source\u003c/h2\u003e \u003cp\u003eThe data for this study is sourced from the 2012 to 2021 NIS database. The NIS database, developed by the Agency for Healthcare Research and Quality (HCUP) is the largest publicly available all-payer administrative claim-based database in the United States contains a 20% random sample of stratified inpatient hospitalization across the United States. discharge weight provided in the dataset is used to establish the national estimate for all U.S. hospitalizations.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eIn this study, we conducted a retrospective analysis of both STEMI and non-STEMI hospitalizations using data extracted from the NIS database. The hospitalizations were identified using international classification of diseases (ICD)-9th Revision and 10th Revision Clinical Modification codes, which are listed in the supplementary table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The codes used to identify hospitalizations of acute ischemic stroke and hemorrhage stroke has been validated by prior studies[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Medical comorbidities were identified using the Elixhauser comorbidities refined for the ICD-9-CM and ICD-10-CM software tools. These tool helps identify and categorize various comorbidities present in the hospitalizations. The hospitalizations were then grouped based on the use of tMCS devices. The groups included: no tMCS use, the use of IABP only, the use of impella only, and the use of ECMO with or without other tMCS devices.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eStatistical analysis was conducted to compare categorical data using χ\u003csup\u003e2\u003c/sup\u003e tests of significance. While the Wilcoxon signed-rank test was employed to compare continuous data.\u003csup\u003e6\u003c/sup\u003e To assess the association between tMCS device utilization and the risk of ischemic and hemorrhagic stroke, univariate and multivariable Cox regression were performed. For the multivariable regression, stepwise forward Cox regression models were utilized to identify significant predictors, with an entry-level p value\u0026thinsp;\u0026lt;\u0026thinsp;0.10. this approach aims to make statistical decisions regarding the inclusion or exclusion of the predictor solely based on their statistical significance, regardless of the underlying biophysiological mechanism.\u003c/p\u003e \u003cp\u003eThe variables included in the multivariable regression model were age, sex, race, hypertension, diabetes mellitus, obesity, smoking status, atrial fibrillation, prior stroke, prior PCI, prior myocardial infarction, prior coronary artery bypass grafting, chronic lung disease, peripheral arterial disease, family history of coronary artery disease, hypothyroidism, hospital size, hospital location and teaching status, primary insurance, IABP use only, impella use only, ECMO use.\u003c/p\u003e \u003cp\u003eCochran-Armitage test was utilized for the trend test. Subgroup analysis was conducted to report the odd ratio (OR) of overall, ischemic, and hemorrhagic stroke in each subgroup, the corresponding ORs and 95% confidence interval (CIs) are presented as forest plots. Statistical significance was defined as a 2-tailed p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05. All analyses were performed using SAS 9.4 (SAS Institute, Cary, NC). Since the database used for the analysis was de-identified, institutional review board approval and informed consent were waived. All analyses were conducted in accordance with the HCUP data use agreement. The authors vouch for the accuracy and completeness of the data.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStudy flow chart and Hospitalization characteristics\u003c/h2\u003e \u003cp\u003eThe study flow chart, depicted in Supplementary 1, illustrates the process of selecting hospitalizations for analysis. Initially, a total of 1,857,807 AMI hospitalizations were extracted from the 2012 to 2021 NIS database. After excluding 115,539 AMI hospitalizations with elective admission, 15,432 with COVID-19 infection, 2,058 with both IABP and Impella used but without ECMO, and 1,678 unspecified tMCS device usage, a final cohort of 1,723,100 hospitalizations were enrolled. After applying the discharge weight provided by the NIS database, the final cohort of the study included a total of 8,274,163 hospitalizations without tMCS treatment, 265,870 with IABP only, 59,240 with Impella only, and 16,225 with ECMO used during the hospitalization. A proportional Venn graph illustrating the proportion of hospitalizations with different modes of tMCS is presented in Supplementary Fig.\u0026nbsp;2.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the baseline characteristics of AMI hospitalization stratified by tMCS devices. In general, hospitalizations treated with tMCS are more likely to occur in large urban teaching hospitals. There are significant differences in management strategies, such as angiography, percutaneous coronary intervention, and coronary artery bypass grafting. The age of hospitalization treated with IABP only and Impella only is comparable to those treated with medical only, However, hospitalizations treated with ECMO are younger, tMCS device-treated hospitalizations are more likely to be male and presented with STEMI. They are also more likely to be diagnosed with cardiogenic shock and cardiac arrest, particularly for hospitalizations treated with ECMO. ECMO-treated hospitalizations have fewer comorbidities, such as hypertension, diabetes mellitus, chronic lung disease, hypothyroidism, and dementia. They are also less likely to have a history of smoking, MI, Prior coronary artery bypass surgery (CABG), and a prior history of stroke.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of AMI hospitalizations stratified by tMCS use\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo tMCS\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;8,275,163\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;4,370,069\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIABP only\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;265,870\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eImpella only\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;59,240\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eECMO\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;16,225\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69 (59\u0026ndash;80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67 (58\u0026ndash;75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68 (60\u0026ndash;77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e61 (52\u0026ndash;68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,388,424 (40.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79,140 (29.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17,350 (29.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4,260 (26.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSTEMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,880,630 (22.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e144,995 (55.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28,015 (47.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10,220 (62.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardiac arrest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e326,450 (3.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40,265 (15.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11,070 (18.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4,370 (26.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRace\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ewhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5,849,834 (73.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e185,240 (73.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40,885 (72.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10,110 (68.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eblack\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e945,790 (11.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21,020 (8.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5,315 (9.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,555 (10.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e656,375 (8.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23,590 (9.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5,310 (9.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,340 (9.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsian/pacific islander\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e218,965 (2.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10,460 (4.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,800 (3.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e585 (3.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNative American\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43,635 (0.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,445 (0.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e505 (0.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e110 (0.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther races\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e226,110 (2.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10,645 (4.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2,465 (4.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e970 (6.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6,329,439 (76.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e193,360 (72.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43,575 (73.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9,240 (56.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,337,619 (40.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e111,890 (42.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27,020 (45.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5,425 (33.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAtrial fibrillation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,824,910 (22.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69,560 (26.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14,470 (24.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3,955 (24.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of smoke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,658,810 (32.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83,945 (31.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15,315 (25.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2,765 (17.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObesity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e831,985 (19.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27,360 (20.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7,845 (18.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2,005 (18.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrior MI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e671,160 (15.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18,120 (13.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6,110 (14.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e750 (7.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrior PCI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e734,670 (16.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17,850 (13.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5,705 (13.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,415 (13.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrior CABG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e457,540 (10.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6,430 (4.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2,825 (6.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e535 (5.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrior stroke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e369,415 (8.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7,805 (5.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2,785 (6.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e330 (3.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeripheral arterial disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e505,595 (11.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17,110 (12.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6,820 (16.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,760 (16.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic lung disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,052,425 (24.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26,405 (19.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8,250 (19.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,425 (13.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ehypothyroidism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e581,775 (13.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13,155 (9.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4,215 (10.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e695 (6.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAutoimmune conditions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e136,665 (3.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,055 (2.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e990 (2.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e190 (1.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDementia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e336,825 (7.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,145 (2.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,325 (3.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e70 (0.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital size (number of beds)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e814,279 (18.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18,110 (13.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5,385 (12.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e505 (4.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,326,219 (30.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39,830 (29.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11,705 (28.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,485 (13.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003elarge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,229,571 (51.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78,065 (57.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24,470 (58.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8,705 (81.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital location/teaching status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e352,720 (8.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6,175 (4.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,295 (3.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e45 (0.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban nonteaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e990,060 (22.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26,525 (19.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6,970 (16.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e555 (5.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban teaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,027,289 (69.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e103,305 (75.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33,295 (80.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10,095 (94.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePayer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedicare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,687,599 (61.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74,935 (55.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25,000 (60.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4,110 (38.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedicaid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e411,855 (9.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13,985 (10.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3,665 (8.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,385 (12.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e953,650 (21.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35,730 (26.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9,460 (22.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4,290 (40.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-pay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e178,515 (4.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6,610 (4.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2,040 (4.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e480 (4.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo charge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15,860 (0.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e530 (0.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100 (0.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e55 (0.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e116,415 (2.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,985 (2.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,225 (2.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e350 (3.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAngiography\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,466,965 (56,45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e119,210 (87.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36,620 (88.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5,375 (50.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePCI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,588,700 (36.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66,375 (48.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33,675 (81.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3,910 (36.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCABG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e247,345 (5.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51,975 (38.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2,900 (6.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2,310 (21.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eValues n (%), or median (interquartile range).\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eAMI: acute myocardial infarction; CABG: coronary artery bypass grafting; CAD: coronary artery disease; ECMO: extracorporeal membrane oxygenation; IABP: intra-aortic balloon pump; PCI: Percutaneous coronary intervention; STEMI: ST segment elevation myocardial infarction.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eRate and trending of stroke in study groups\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the rates of stroke for different treatment groups. The overall stroke rates for patients who treated without tMCS, IABP only, Impella only, and ECMO group were 3.41%, 3.46% 4.51%, and 13.34% respectively. Specifically, the rates of ischemic stroke for these groups were 2.95%, 3.12%, 3.96% and 10.11% respectively. The rates for hemorrhagic stroke were 0.68%, 0.55%, 0.81%, and 4.90% for the same groups. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e also includes other in-hospital outcomes that were analyzed.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIn-hospital outcomes in tMCS treated AMI hospitalizations stratified by tMCS use\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo tMCS\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;8,274,163\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIABP only\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;265,870\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eImpella only\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;59,240\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eECMO\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;16,225\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStroke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e282,275 (3.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9,210 (3.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2,670 (4.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2,165 (13.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIschemic stroke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e244,200 (2.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8,305 (3.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2,345 (3.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,640 (10.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemorrhagic Stroke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56,420 (0.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,450 (0.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e480 (0.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e795 (4.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn-Hospital death\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e624,145 (7.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50,805 (19.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18,835 (31.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9,050 (55.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBleeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e718,525 (8.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43,785 (16.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10,655 (17.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5,210 (32.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcute kidney injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,140,390 (25.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100,795 (37.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29,945 (50.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12,000 (73.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNew dialysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e87,260 (1.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6,930 (4.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4,275 (8.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2,760 (21.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardiac tamponade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10,065 (0.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,510 (0.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e745 (1.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e840 (5.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcquired pneumonia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e416,060 (5.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14,615 (5.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2,510 (4.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,610 (9.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSepsis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e792,100 (9.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22,985 (8.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7,085 (11.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3,685 (22.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTracheostomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52,410 (0.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6,870 (2.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,410 (2.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,695 (10.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDischarge status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRoutine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4,485,314 (54.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84,865 (31.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16,985 (28.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,080 (6.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHome health care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,081,050 (13.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46,230 (17.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7,305 (12.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e940 (5.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther care facility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,980,665 (23.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82,865 (31.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15,885 (26.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5,135 (31.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of stay, days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (2\u0026ndash;7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (4\u0026ndash;12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (3\u0026ndash;12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (4\u0026ndash;24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean cost, \u003cspan\u003e$\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15,636 (9,001\u0026ndash;25,382)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42,498 (26,584\u0026thinsp;\u0026minus;\u0026thinsp;65,193)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64,304 (46,380\u0026thinsp;\u0026minus;\u0026thinsp;90,782)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e124,695 (69,202\u0026ndash;221,595)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eValues n (%), or median (interquartile range).\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eAMI: acute myocardial infarction; CABG: coronary artery bypass grafting; CAD: coronary artery disease; ECMO: extracorporeal membrane oxygenation; IABP: intra-aortic balloon pump; PCI: Percutaneous coronary intervention; STEMI: ST segment elevation myocardial infarction; tMCS: temporary mechanical circulatory support\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe quarterly rates of overall stroke, ischemic stroke, and hemorrhagic stroke for each group are reported in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. There has been an increasing trend of overall stroke and ischemic stroke in the Impella used only group. In contrast, the rates have remained stable in the other groups throughout the study period. Furthermore, the remarkably high risk of stroke associated with ECMO treatment is consistent across the entire study period. This consistency is observed in the rates of overall stroke, ischemic stroke, and hemorrhagic stroke.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003ePredictor of stroke\u003c/h2\u003e \u003cp\u003eIn the univariate Cox regression analysis, it was found that the use of ECMO was a major predictor of overall stroke, with an odds ratio (OR) of 4.25 and a 95% confidence interval (CI) of 3.75 to 4.83. This was followed by ages older than 75 years compared to ages younger than 50, with an OR of 1.62 and a 95% CI of 1.54 to1.69. Other significant predictors included atrial fibrillation (OR 1.59, 95% CI [1.56\u0026ndash;1.63]), female sex (OR 1.41, 95%CI [1.38\u0026ndash;1.44]), use of Impella (OR 1.35, 95%CI [1.21\u0026ndash;1.49]), and prior history of stroke (OR 1.32, 95%CI [1.28\u0026ndash;1.38]). In the stepwise forward Cox regression analysis, after adjusting for other variables the adjusted OR (aOR) of ECMO use for overall stroke was 3.04 (95%CI [2.66\u0026ndash;3.48]), this was followed by Impella use with an aOR of 1.79 (95%CI [1.61-2.00]), and atrial fibrillation (aOR 1.34, 95%CI [1.31\u0026ndash;1.38]). However, the use of IABP was not found to be associated with an increased risk of stroke in both univariate and multivariate regressions, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. For further details on the univariate and stepwise forward selection multivariate regression for ischemic stroke and hemorrhagic stroke, please refer to supplementary tables 2 and 3 respectively.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate and multivariate regression for the risk of overall stroke\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"18\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c16\" colnum=\"16\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c17\" colnum=\"17\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c18\" colnum=\"18\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"8\" nameend=\"c10\" namest=\"c3\"\u003e \u003cp\u003eUnivariate regression\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"8\" nameend=\"c18\" namest=\"c11\"\u003e \u003cp\u003eMultivariate regression\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eLower CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eUpper CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003eaOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003eLower CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003eUpper CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c17\" namest=\"c16\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c18\" namest=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eECMO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e4.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e3.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e4.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e3.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e2.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e3.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eage\u0026thinsp;\u0026gt;\u0026thinsp;75 Vs age\u0026thinsp;\u0026lt;\u0026thinsp;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e1.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e1.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e1.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAtrial fibrillation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e1.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e1.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e1.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e1.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e1.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eImpella only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e1.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e1.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePrior stroke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e1.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e1.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e1.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e50\u0026thinsp;\u0026le;\u0026thinsp;AGE\u0026thinsp;\u0026le;\u0026thinsp;75 Vs age\u0026thinsp;\u0026lt;\u0026thinsp;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e1.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e1.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eperipheral vascular disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e1.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e1.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e1.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eIABP only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMedicaid vs Medicare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e1.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e1.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHypothyroidism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eChronic lung disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eWhite race\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSmall bedsize of hospital/Large bedsize of hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eRural/Urban teaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePrior CABG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eRural/urban nonteaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eObesity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSmoke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePrivate insurance vs Medicare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePrior MI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePrior PCI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eFamily history of CAD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePCI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"18\"\u003eCABG: coronary artery bypass grafting; CAD: coronary artery disease; ECMO: extracorporeal membrane oxygenation; IABP: intra-aortic balloon pump; PCI: Percutaneous coronary intervention; STEMI: ST segment elevation myocardial infarction; tMCS: temporary mechanical circulatory support.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eSubgroup analysis\u003c/h2\u003e \u003cp\u003eThe findings above indicate a clear association between the use of ECMO and a significantly increased risk of overall, ischemic, and hemorrhagic stroke. Subgroup analysis was performed to assess the risk of stroke in specific subgroups, including gender, age, race, hypertension, diabetic mellitus, atrial fibrillation, as well as STEMI presentations. The analysis revealed that hospitalization with age younger than 50 years old, those without hypertension, and those presented with STEMI are at particularly high risk of stroke, as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e (p for interaction\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for all). Subgroup analysis to assess the risk of overall stroke for IABP and Impella is shown in Supplementary Figure S3 and S4 respectively, Subgroup analysis to assess the risk of ischemic and hemorrhagic stroke for different tMCS treated AMI is shown in Supplementary Figure S5-10.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe use of tMCS for patients with cardiogenic shock complicated AMI has increased dramatically despite lacking convincing evidence showing the clinical benefits [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Moreover, the risk of stroke associated with tMCS devices has rarely been investigated.\u003c/p\u003e \u003cp\u003eTo our knowledge, this is the first large sample study with robust analysis to investigate the risk of stroke for different models of tMCS devices used in AMI hospitalizations. The main finding are as follows: 1) IABP use alone does not increase the risk of overall, ischemic, and hemorrhagic stroke; 2) Impella use alone slightly increase the risk of overall, ischemic, and hemorrhagic stroke; 3) ECMO use associated with remarkably high risk of overall, ischemic, and hemorrhagic stroke; 4) hospitalizations younger than 50 years old, those without hypertension, and those with STEMI are at particularly high risk of stroke when treated with ECMO.\u003c/p\u003e \u003cp\u003eIABP continues to be the primary choice for tMCS during hospitalization for AMI. Despite uncertainties surrounding the survival advantages of IABP. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], it is somewhat reassuring that there is no indication of increased risk of stroke associated with its use.\u003c/p\u003e \u003cp\u003eThe utilization of Impella has seen a significant rise, particularly following the IABP-SHOCK II trial [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The publication of DanGer Shock[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] result will undoubtably further encourage clinician to deploy impella for the mechanical circulatory support in cardiogenic shock complicated AMI. The rate of stroke in impella treated group are 3.9% compared to 2.3% in standard care group[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Consistent to these findings, this large sample analysis reports an increased risk of stroke for the Impella treated AMI. and trending for more ischemic and hemorrhagic cerebral event. The impella device have a larger profile and necessitate the use of larger caliber catheters for implantation, which inevitability increases the risk of vascular complications. In addition, the implantation of the Impella device requires crossing the aortic arch and aortic valve, which may contribute to more stroke events.\u003c/p\u003e \u003cp\u003eAnother potential reason for the increased occurrence of stroke with Impella could be attributed to hemodynamic changes. Unlike IABP, which augment the pulsatile blood flow, the continuous flow generated by Impella can lead to alterations in blood flow patterns, these abnormal flow pattern can create areas of stasis or turbulent flow, promoting the formation of blood clots thereby contributing to the increased risk of stroke.\u003c/p\u003e \u003cp\u003eData are scarce regarding the utilization of ECMO in cases of cardiogenic shock complicated AMI [\u003cspan additionalcitationids=\"CR14 CR15\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e–\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Recent ECLS-ECMO trial[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] found that early routine ECMO was not superior to usual medical therapy alone in terms of mortality within 30 days. prior studies showed, the use of ECMO has been associated with a significantly increased risk of stroke[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], with ischemic stroke being the most common type[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. An analysis of 153 patients with VA-ECMO reported 8.4% acute ischemic stroke and 3.9% hemorrhagic stroke[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], which are comparable with the rates of stroke reported by our study.\u003c/p\u003e \u003cp\u003eThe mechanisms through which ECMO use contributes to an increased risk of stroke are multifactorial. Firstly, similar to the altered blood flow pattern caused by Impella, continuous blood flow from ECMO can increase the chance of thrombosis. Secondly, the presence of foreign surfaces like gas exchange membranes and hollow fibers in the ECMO oxygenator can activate the coagulation cascade, leading to an increased risk of clot formation. Additionally, blood flow through the oxygenator may result in the destruction of red blood cells causing hemolysis. Even at a low level, hemolysis during ECMO support could potentially raise the risk of stroke[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. lastly, when VA-ECMO peripheral cannulation causes the retrograde flow to the proximal aorta, it significantly increases the afterload on the left ventricle. This, in turn, can lead to left ventricular distension, blood flow stagnation, and the formation of thrombi within the left ventricle[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFurthermore, the use of anticoagulant medications, which are often essential to prevent clotting in patients with Impella and ECMO devices, can also increase the risk of hemorrhagic stroke, balancing the need for anticoagulation to prevent clotting with the risk of bleeding complication is challenging in managing patients treated with Impella and ECMO.\u003c/p\u003e \u003cp\u003eGiven the potential severity of the stroke and its impact on patient outcomes, it is crucial that further research be conducted to better understand the risk factors, and prevention strategies associated with stroke in patients with Impella and ECMO use. In addition, advances in device technology should focus on minimizing the risk of stroke, this could involve the development of more biocompatible materials that reduce the formation of blood clots, as well as improving flow dynamic patterns. Additionally, optimizing anticoagulation protocols and monitoring strategies could help strike a balance between preventing clotting and minimizing bleeding complications.\u003c/p\u003e "},{"header":"Limitations","content":"\u003cp\u003eThe present study had several limitations that should be noted. The administrative database lacked clinical details, such as hemodynamic, metabolite, medication, biochemistry, and imaging data, and there were no long-term follow-up data in the NIS dataset. Coding errors and underreporting of secondary diagnoses were also potential sources of bias. Additionally, as with all retrospective observational studies, even with robust confounder adjustment, residue confounding was inherent. The indications for ECMO, IABP, and Impella may vary between hospitals; therefore, selection bias was inevitable. Moreover, more granular data about the severity of stroke and Rankin Scales were not available. However, the NIS database has been extensively validated in previous publications[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. This study included the largest sample of hospitalization comparing the rate of overall, ischemic, and hemorrhagic stroke, robust analyses were performed by multivariable regression and subgroup analysis.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study investigating the rates, trends, and predictors of stroke in AMI hospitalizations treated with different tMCS devices. IABP use alone does not increase the risk of overall, ischemic, and hemorrhagic stroke. However, Impella and ECMO use associated with significant high risk of risk of overall, ischemic, and hemorrhagic stroke, particularly with the ECMO treatment. Further studies are warranted to illustrate the mechanism and to explore the strategies to reduce the risk of stroke.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no competing interests to declare that are relevant to the content of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Funding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was funded by the Health Technology Capability Enhancement Project of Jilin Province (2022JC054), the Scientific and Technological Developing Plan of Jilin Province (YDZJ202401287ZYTS, YDZJ202201ZYTS098), the Science and Technology Research of Jilin Provincial Department of Education (JJKH20231213KJ).\u003c/p\u003e\n\u003cp\u003eHuman Ethics and Consent to Participate declarations: not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe study data can be accessed from the website (\u003ca href=\"https://www.hcup-us.ahrq.gov/\"\u003ehttps://www.hcup-us.ahrq.gov/\u003c/a\u003e) under appropriate data use agreements.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eTung CY, Granger CB, Sloan MA, Topol EJ, Knight JD, Weaver WD, Mahaffey KW, White H, Clapp-Channing N, Simoons ML \u003cem\u003eet al\u003c/em\u003e: Effects of stroke on medical resource use and costs in acute myocardial infarction. 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J Am Heart Assoc 2015, 4(12).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eColumbo JA, Kang R, Trooboff SW, Jahn KS, Martinez CJ, Moore KO, Austin AM, Morden NE, Brooks CG, Skinner JS \u003cem\u003eet al\u003c/em\u003e: Validating Publicly Available Crosswalks for Translating ICD-9 to ICD-10 Diagnosis Codes for Cardiovascular Outcomes Research. Circ Cardiovasc Qual Outcomes 2018, 11(10):e004782.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZachrison KS, Li S, Reeves MJ, Adeoye O, Camargo CA, Schwamm LH, Hsia RY: Strategy for reliable identification of ischaemic stroke, thrombolytics and thrombectomy in large administrative databases. Stroke Vasc Neurol 2021, 6(2):194\u0026ndash;200.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStretch R, Sauer CM, Yuh DD, Bonde P: National Trends in the Utilization of Short-Term Mechanical Circulatory Support: Incidence, Outcomes, and Cost Analysis. Journal of the American College of Cardiology 2014, 64(14):1407\u0026ndash;1415.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGeller BJ, Sinha SS, Kapur NK, Bakitas M, Balsam LB, Chikwe J, Klein DG, Kochar A, Masri SC, Sims DB \u003cem\u003eet al\u003c/em\u003e: Escalating and De-escalating Temporary Mechanical Circulatory Support in Cardiogenic Shock: A Scientific Statement From the American Heart Association. Circulation 2022, 146(6):e50-e68.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, Richardt G, Hennersdorf M, Empen K, Fuernau G \u003cem\u003eet al\u003c/em\u003e: Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 2012, 367(14):1287\u0026ndash;1296.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, de Waha A, Richardt G, Hennersdorf M, Empen K \u003cem\u003eet al\u003c/em\u003e: Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial. Lancet 2013, 382(9905):1638\u0026ndash;1645.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eM\u0026oslash;ller JE, Engstr\u0026oslash;m T, Jensen LO, Eiskj\u0026aelig;r H, Mangner N, Polzin A, Schulze PC, Skurk C, Nordbeck P, Clemmensen P \u003cem\u003eet al\u003c/em\u003e: Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock. New England Journal of Medicine 2024, 390(15):1382\u0026ndash;1393.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOstadal P, Rokyta R, Karasek J, Kruger A, Vondrakova D, Janotka M, Naar J, Smalcova J, Hubatova M, Hromadka M \u003cem\u003eet al\u003c/em\u003e: Extracorporeal Membrane Oxygenation in the Therapy of Cardiogenic Shock: Results of the ECMO-CS Randomized Clinical Trial. Circulation 2023, 147(6):454\u0026ndash;464.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrunner S, Guenther SPW, Lackermair K, Peterss S, Orban M, Boulesteix AL, Michel S, Hausleiter J, Massberg S, Hagl C: Extracorporeal Life Support in Cardiogenic Shock Complicating Acute Myocardial Infarction. J Am Coll Cardiol 2019, 73(18):2355\u0026ndash;2357.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOuweneel DM, Schotborgh JV, Limpens J, Sjauw KD, Engstr\u0026ouml;m AE, Lagrand WK, Cherpanath TGV, Driessen AHG, de Mol B, Henriques JPS: Extracorporeal life support during cardiac arrest and cardiogenic shock: a systematic review and meta-analysis. Intensive Care Med 2016, 42(12):1922\u0026ndash;1934.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBanning AS, Sabat\u0026eacute; M, Orban M, Gracey J, L\u0026oacute;pez-Sobrino T, Massberg S, Kastrati A, Bogaerts K, Adriaenssens T, Berry C \u003cem\u003eet al\u003c/em\u003e: Venoarterial extracorporeal membrane oxygenation or standard care in patients with cardiogenic shock complicating acute myocardial infarction: the multicentre, randomised EURO SHOCK trial. EuroIntervention 2023, 19(6):482\u0026ndash;492.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThiele H, Zeymer U, Akin I, Behnes M, Rassaf T, Mahabadi AA, Lehmann R, Eitel I, Graf T, Seidler T \u003cem\u003eet al\u003c/em\u003e: Extracorporeal Life Support in Infarct-Related Cardiogenic Shock. New England Journal of Medicine 2023, 389(14):1286\u0026ndash;1297.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNishikawa M, Willey J, Takayama H, Kaku Y, Ning Y, Kurlansky PA, Brodie D, Masoumi A, Fried J, Takeda K: Stroke patterns and cannulation strategy during veno-arterial extracorporeal membrane support. J Artif Organs 2022, 25(3):231\u0026ndash;237.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLe Guennec L, Cholet C, Huang F, Schmidt M, Br\u0026eacute;chot N, H\u0026eacute;kimian G, Besset S, Lebreton G, Nieszkowska A, Leprince P \u003cem\u003eet al\u003c/em\u003e: Ischemic and hemorrhagic brain injury during venoarterial-extracorporeal membrane oxygenation. Ann Intensive Care 2018, 8(1):129.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eProkupets R, Kannapadi N, Chang H, Caturegli G, Bush EL, Kim BS, Keller S, Geocadin RG, Whitman GJR, Cho SM: Management of Anticoagulation Therapy in ECMO-Associated Ischemic Stroke and Intracranial Hemorrhage. Innovations (Phila) 2023, 18(1):49\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaeed O, Jakobleff WA, Forest SJ, Chinnadurai T, Mellas N, Rangasamy S, Xia Y, Madan S, Acharya P, Algodi M \u003cem\u003eet al\u003c/em\u003e: Hemolysis and Nonhemorrhagic Stroke During Venoarterial Extracorporeal Membrane Oxygenation. Ann Thorac Surg 2019, 108(3):756\u0026ndash;763.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eElgendy IY, Gad MM, Mahmoud AN, Keeley EC, Pepine CJ: Acute Stroke During Pregnancy and Puerperium. J Am Coll Cardiol 2020, 75(2):180\u0026ndash;190.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu J, Fan Y, Zhao W, Li B, Pan N, Lou Z, Zhang M: In-Hospital Outcomes of Acute Myocardial Infarction With Essential Thrombocythemia and Polycythemia Vera: Insights From the National Inpatient Sample. J Am Heart Assoc 2022, 11(24):e027352.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Acute myocardial infarction, stroke, IABP, Impella, ECMO","lastPublishedDoi":"10.21203/rs.3.rs-4629600/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4629600/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjectives\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe aim of this study was to assess the risk of stroke for temporary mechanical circulatory support (tMCS) device treated acute myocardial infarction (AMI).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData are limited regarding risk of stroke for temporary mechanical circulatory support (tMCS) device treated acute myocardial infarction (AMI).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe national inpatient sample database was analyzed to identify adults who were hospitalized for AMI between 2012 and 2021, hospitalizations were grouped based on the temporary mechanical circulatory support device.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the final cohort, there are 8,272,163 (96.0%) weighted hospitalizations treated without tMCS, 265,870 (3.1%) with Intra-Aortic Balloon Pump (IABP) alone, 59,240 (0.7%) with Impella alone, and 16,225 (0.2%) with Extracorporeal Membrane Oxygenation (ECMO) used during the hospitalization.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003eThe overall stroke rates for patients who treated without tMCS, IABP alone, Impella alone, and ECMO group were 3.41%, 3.46%, 4.51%, and 13.34% respectively. Specifically, the rates of ischemic stroke for these groups were 2.95%, 3.12%, 3.96% and 10.11% respectively. The rates for hemorrhagic stroke were 0.68%, 0.55%, 0.81%, and 4.90% for the same groups. In the stepwise forward Cox regression analysis, the adjusted OR (aOR) of ECMO use for overall stroke was 3.04 (95%CI [2.66-3.48]), followed by Impella only use with an aOR of 1.79 (95%CI [1.61-2.00]), and atrial fibrillation (aOR 1.34, 95%CI [1.31-1.38]). The subgroup analysis revealed that hospitalization with age younger than 50 years old, those without hypertension, and those presented with ST-elevation myocardial infarction are at particularly high risk of stroke for ECMO treated AMI.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e This ten years AMI hospitalizations analysis revealed that ECMO and Impella treatment associated with increased risk of both ischemic and hemorrhagic stroke. Particularly for those younger than 50, those without hypertension, and those presented with ST-elevation myocardial infarction. However, treatment with IABP alone does not increase the risk of stroke.\u003c/p\u003e","manuscriptTitle":"Risk of stroke for AMI treated with temporary mechanical circulatory support: ten-year data from National Inpatient Sample","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-24 13:46:00","doi":"10.21203/rs.3.rs-4629600/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-03-31T14:27:21+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-03-31T02:51:29+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-03-25T10:53:36+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-03-24T01:30:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"1609363499090860759033675364768802335","date":"2025-03-19T18:58:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"264868685884695176010683327592850816088","date":"2025-03-18T07:53:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"151128414246633233617048138799531496138","date":"2025-03-18T03:08:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"238150070094176910127876081947048037243","date":"2025-03-18T01:58:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"142118993572421667349047068382186585846","date":"2024-07-15T22:11:34+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-13T19:51:59+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-13T19:50:07+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-07-02T20:39:56+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-07-02T03:52:08+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-06-24T10:47:18+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9710a874-3897-4dd9-9e08-4ef7d2a2982b","owner":[],"postedDate":"July 24th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":34813912,"name":"Health sciences/Cardiology"},{"id":34813913,"name":"Health sciences/Neurology"}],"tags":[],"updatedAt":"2025-07-21T16:05:27+00:00","versionOfRecord":{"articleIdentity":"rs-4629600","link":"https://doi.org/10.1038/s41598-025-10555-4","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-07-14 15:57:36","publishedOnDateReadable":"July 14th, 2025"},"versionCreatedAt":"2024-07-24 13:46:00","video":"","vorDoi":"10.1038/s41598-025-10555-4","vorDoiUrl":"https://doi.org/10.1038/s41598-025-10555-4","workflowStages":[]},"version":"v1","identity":"rs-4629600","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4629600","identity":"rs-4629600","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}