Bleeding complication in prolonged transaxillary support with microaxial flow pump for acute myocardial infarction cardiogenic shock: insights from a referral center

Abstract Introduction Bleeding is the most frequent complication of microaxial flow pump support in cardiogenic shock (CS) and may jeopardize outcomes. We assessed incidence, timing and type of bleeding in a contemporary cohort of AMI-CS patients supported with mAFP. Methods Observational study on all adult AMI-CS patients receiving transaxillary Impella support at an Italian referral center from 2018 to 2024. Results 91% were male and mean age was 60 (54–66) years. All patients were SCAI D (34%) or E (66%). Bleeding was recorded in 31 patients (58%): 34% had major bleeding and 66 % minor bleeding. Bleeding was gastrointestinal in 25% of cases, airway bleeding occurred in 19% , pericardial effusion in 6% and intracerebral hemorrage in 4%. Bleeding complications occurred early during support - as we noted that the first bleeding occurred on average after 3 (1-4)days of support - and was a recurrent complication, since 74% of bleeders had multiple bleeding episodes. Overall we recorded 41 bleedings in the first 7 days of support and 21 after the first week of support, of which only 6 after 21 days of support. Neither duration of mAFP support, nor the recurrence to VA ECMO were associated with bleeding risk; on the contrary, the duration of concomitant VA ECMO and Impella support was associated with increased bleeding risk (p=0.014, see table 1). Conclusions Bleeding complications remain frequent in mAFP supported patients but does not jeopardize outcomes. Not the duration of mAFP support, rather he duration of ECPELLA might confer an increased bleeding risk.Table 1.Periprocedural dataFor image description, please refer to the figure legend and surrounding text.