Key result
Early Impella before anterior STEMI PCI is linked to ~11% higher LVEF versus no Impella.
Why the study?
The clinical efficacy of the Impella for high-risk PCI and cardiogenic shock remains under debate.
Does early Impella use pre-PCI improve subacute left ventricular function in patients with broad anterior STEMI and cardiogenic shock?
Cohort (n=25)
No
Does early Impella use pre-PCI improve subacute left ventricular function in patients with broad anterior STEMI and cardiogenic shock?
Absolute Event Rate: 45% vs 34%
p-value: p=0.034
Early Impella implantation before PCI in anterior STEMI with cardiogenic shock preserves subacute left ventricular function and myocardial strain compared to non-Impella strategies.
Supports evaluation of early Impella in anterior STEMI shock; hypothesis-generating and requires randomized confirmation before practice change.
BACKGROUND: The clinical efficacy of the Impella for high-risk percutaneous coronary intervention (PCI) and cardiogenic shock remains under debate. We thus sought to investigate the protective effects on the heart with the Impella's early use pre-PCI using cardiac magnetic resonance imaging (CMRI). METHODS: We retrospectively evaluated the difference in the subacute phase CMR imaging results (19 ± 9 days after admission) between patients undergoing an Impella (n = 7) or not (non-Impella group: n = 18 [12 intra-aortic balloon pumps (1 plus veno-arterial extracorporeal membrane oxygenation) and 6 no mechanical circulation systems]) in broad anterior ST-elevation myocardial infarction (STEMI) cases. A mechanical circulation system was implanted pre-PCI. RESULTS: No differences were found in the door-to-balloon time, peak creatine kinase, and hospital admission days between the Impella and non-Impella groups; however, the CMRI-derived left ventricular ejection fraction was significantly greater (45 ± 13% vs. 34 ± 7.6%, P = 0.034) and end-diastolic and systolic volumes smaller in the Impella group (149 ± 29 vs. 187 ± 41 mL, P = 0.006: 80 ± 29 vs. 121 ± 40 mL, P = 0.012). Although the global longitudinal peak strain did not differ, the global radial (GRS) and circumferential peak strain (GCS) were significantly higher in the IMPELLA than non-IMPELLA group. Greater systolic and diastolic strain rates (SRs) in the Impella than non-Impella group were observed in non-infarcted rather than infarcted areas. CONCLUSIONS: Early implantation of an Impella before PCIs for STEMIs sub-acutely prevented cardiac dysfunction through preserving the GRS, GCS, and systolic and diastolic SRs in the remote myocardium. This study provided mechanistic insight into understanding the usefulness of the Impella to prevent future heart failure.
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Fukamachi et al. (2022) conducted a cohort in Broad anterior ST-elevation myocardial infarction (STEMI) (n=25). Impella vs. Non-Impella (IABP, VA-ECMO, or no mechanical circulation system) was evaluated on CMRI-derived left ventricular ejection fraction (LVEF) (p=0.034). Early implantation of an Impella before percutaneous coronary intervention for broad anterior ST-elevation myocardial infarction significantly preserved left ventricular ejection fraction (45% vs. 34%, P=0.034) compared to non-Impella treatment.
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