Key result
In patients with acute cardiogenic shock supported by large Impella devices, in-hospital and 30-day mortality rates were 56.7% and 48.9%, respectively.
Why the study?
Large Impella systems help achieve better outcomes via left ventricular unloading in acute cardiogenic shock, prompting an evaluation of clinical outcomes based on individual clinical scenarios.
Observational (n=90)
No
In patients with acute cardiogenic shock, large Impella support is associated with high mortality, though younger age and lower lactate levels predict successful bridging to permanent support or transplantation.
Impella 5+ outcomes in acute CS vary by etiology and adjunctive support; leaves open optimal selection and efficacy without prospective trials.
BACKGROUND: Large Impella systems (5.0 or 5.5; i.e., Impella 5+) (Abiomed Inc., Danvers, MA, USA) help achieve better clinical outcomes through relevant left ventricular unloading in acute cardiogenic shock (CS). Here, we report our experience with Impella 5+, while focusing on the clinical outcomes depending on individual case scenarios in patients with acute CS. METHODS: This single-center retrospective observational study included 100 Impella 5+ implantations conducted on patients with acute CS from November 2018 to October 2021. After excluding 10 reimplantation cases, 90 cases were enrolled for further analysis. RESULTS: In-hospital and 30-day mortality rates were 56.7% (n = 51) and 48.9% (n = 44), respectively. In-hospital mortality was lower in patients with acute myocardial infarction (AMI) than in non-AMI patients (p = 0.07). Young age and low lactate levels were the independent predictors of successful transition and survival after permanent mechanical circulatory support/heart transplantation (pMCS/HTX) (age, p = 0.03; lactate level, p = 0.04; survived after pMCS/HTX, n = 11; died on Impella, n = 41). During simultaneous utilization of venoarterial extracorporeal membrane oxygenation therapy and Impella 5+, termed ECMELLA therapy, high dose of noradrenaline was a predictive factor for in-hospital mortality by multivariate analysis (n = 0.02). CONCLUSIONS: Our results suggest that enhanced Impella support might have better clinical outcomes among acute CS patients supported with large Impella, those with AMI than those with no AMI. Young age and low lactate levels were predictors of successful bridging to pMCS/HTX and favorable clinical outcomes thereafter. The clinical outcomes of ECMELLA therapy might depend on noradrenaline dose at the time of Impella 5+ implantation.
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Sugimura et al. (2023) conducted an observational in Acute cardiogenic shock (n=90). Large Impella systems (5.0 or 5.5) was evaluated on In-hospital mortality. In patients with acute cardiogenic shock supported by large Impella devices, in-hospital and 30-day mortality rates were 56.7% and 48.9%, respectively.
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