Timing of Impella implantation and outcomes in cardiogenic shock or high‐risk percutaneous coronary revascularization
Key result
Pre-PCI Impella is linked to improved one-year survival and ~89% less severe bleeding versus during/after PCI.
- P=0.009
- n=365
Why the study?
A better understanding of the safety, effectiveness, and timing of Impella initiation in specific clinical settings was needed.
Does pre-PCI Impella implantation improve survival compared to during/after PCI implantation in patients with cardiogenic shock or undergoing high-risk PCI?
Population
365 patients treated with Impella 2.5/CP in 17 centers
Comparison
Pre-PCI Impella implantation vs during or after PCI
Design
Multicenter registry with propensity-score weighting analysis
Follow-up
1-year
Authors
Discussion
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Member takes
Implication
May support pre-PCI Impella in shock or high-risk PCI; leaves open randomized confirmation of survival benefit.
Study Design
Type
Observational (n=365)
Multicenter
Yes
Structured PICO
Does pre-PCI Impella implantation improve survival compared to during/after PCI implantation in patients with cardiogenic shock or undergoing high-risk PCI?
P
Population
365 patients with cardiogenic shock or undergoing high-risk PCI treated with Impella 2.5/CP, evaluated for 1-year clinical outcomes.
E
Exposure
Pre-percutaneous coronary intervention (pre-PCI) implantation of a microaxial percutaneous mechanical circulatory support device (Impella 2.5/CP).
C
Comparator
Impella 2.5/CP implantation during or after percutaneous coronary intervention (PCI).
O
Outcome
1-year survivalhard clinical
Main Result
p-value: p=0.009
Initiating Impella mechanical circulatory support prior to PCI, rather than during or after the procedure, is associated with improved 1-year survival and lower bleeding risk in patients with AMI-cardiogenic shock or undergoing high-risk PCI.
Cite This Study
Tarantini et al. (2021) conducted an observational in Cardiogenic shock and high-risk percutaneous coronary intervention (PCI) (n=365). Pre-PCI Impella implantation vs. Impella implantation during or after PCI was evaluated on 1-year survival (p=0.009). Pre-PCI Impella implantation improved 1-year survival in cardiogenic shock (P=0.009) and reduced severe bleeding in high-risk PCI (1% vs 9%, P=0.02) compared to during/after PCI.