Key result
Specialized LVAD center care is linked to ~21% lower 30-day mortality in AMI-CS on ECPELLA.
Why the study?
The prognosis of AMI-CS treated with ECPELLA remains poor, and it was uncertain whether management at an LVAD center confers a survival advantage compared with a non-LVAD center.
Does management at a specialized LVAD center reduce 30-day mortality compared to a non-LVAD center in patients with AMI-related cardiogenic shock treated with ECPELLA?
Cohort (n=1,549)
Yes
Does management at a specialized LVAD center reduce 30-day mortality compared to a non-LVAD center in patients with AMI-related cardiogenic shock treated with ECPELLA?
In patients with AMI-related cardiogenic shock receiving ECPELLA support, management at a specialized LVAD center and upgrading to an Impella 5.0/5.5 device are independently associated with lower 30-day mortality.
May support LVAD center referral for AMI-CS on ECPELLA; hypothesis-generating and needs prospective confirmation.
Background The prognosis of patients with acute myocardial infarction-related cardiogenic shock (AMI-CS) treated with veno-arterial extracorporeal life support (VA-ECLS) combined with Impella (i.e., ECPELLA) remains poor. Whether management at LVAD center confers a prognostic advantage compared with non-LVAD center remains uncertain. Purpose This study aimed to compare 30-day mortality between LVAD center and non-LVAD center among patients with AMI-CS receiving ECPELLA support, using data from the prospectively collected nationwide J-PVAD registry. Methods Among 4,910 patients who underwent Impella placement for AMI-CS between 2020 and 2023, those receiving ECPELLA were included in the final analysis. Exchange of Impella to the 5.0/5.5 device was defined as device upgrade. Cumulative mortality and adverse events were retrospectively compared between LVAD center and non-LVAD center. Results A total of 1,549 patients (median age 69 years; LVAD center 21.1%) were analyzed. The 30-day mortality was significantly lower at LVAD center than at non-LVAD center (45.5% versus 54.5%, p = 0.002; Figure). Management at LVAD center and Impella upgrade were independently associated with lower 30-day mortality, with adjusted hazard ratio of 0.791 (95% CI 0.658-0.953, p = 0.013) and 0.483 (95% CI 0.339-0.690, p < 0.001), respectively, instead of LVAD implantation. Conclusions Impella upgrade and management at LVAD center were associated with reduced 30-day mortality in patients with AMI-CS receiving ECPELLA. Further approaches are warranted to establish a standardized and regionalized network of care for cardiogenic shock.
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Nakamura et al. (2026) conducted a cohort in Acute myocardial infarction-related cardiogenic shock (AMI-CS) treated with ECPELLA (VA-ECLS combined with Impella) (n=1,549). Management at specialized LVAD center vs. Management at non-LVAD center was evaluated on 30-day mortality (HR 0.791, 95% CI 0.658-0.953, p=0.013). Management at a specialized LVAD center was associated with lower 30-day mortality in AMI-CS patients on ECPELLA vs non-LVAD centers (45.5% vs 54.5%; aHR 0.791, 95% CI 0.658-0.953; P=0.013).
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