Key result
Late Impella initiation in AMI and CS linked to worse clinical outcomes.
Observational
No
In a single-center experience of 30 patients, late initiation of Impella in AMI cardiogenic shock was associated with worse outcomes, suggesting early initiation ('door to unloading') may be beneficial.
May favor early Impella in AMI shock; leaves open benefit pending randomized confirmation.
We report the outcome of patients supported with the Impella device at our institution. Similar to the interim analysis of J-PVAD registry presented at the 84th Annual Scientific Meeting of the Japanese Circulation Society, we observed a worse outcome in patients with AMI cardiogenic shock who received late Impella support. It is also important to highlight that only one patient of this cohort received Impella support before reperfusion at our institute. A door to unloading strategy as opposed to one emphasizing door to balloon combined with earlier initiation of Impella support seems promising1) and it the creation of a system that embraces door to unloading which is both our institute’s challenge and opportunity to improve outcomes.
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Iida et al. (2021) conducted an observational in AMI cardiogenic shock. Impella (Percutaneous Left Ventricular Assist Device) was evaluated on Clinical outcome. Late initiation of Impella support in patients with acute myocardial infarction and cardiogenic shock was associated with worse clinical outcomes.
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