Impella use in elderly dialysis patients is associated with an increased risk of lower extremity ischemia: insights from the japanese registry for percutaneous ventricular assist device

Background Mechanical circulatory support with Impella may improve outcomes in cardiogenic shock [1, 2] ; however, device-related complications remain frequent and occasionally fatal [3]. The incidence and predictors of complications in dialysis patients have not been fully characterized. Purpose To determine the incidence and predictors of Impella-related complications in dialysis patients. Methods We analyzed 4,032 patients enrolled in the Japanese Registry for Percutaneous Ventricular Assist Device (J-PVAD) between February 2020 and December 2022. Among them, 212 were receiving dialysis. Complication rates were compared between dialysis and non-dialysis patients. Predictors of lower extremity ischemia in dialysis patients were assessed using logistic regression. Survival was evaluated using Kaplan–Meier analysis. Results Dialysis patients had a significantly higher incidence of lower extremity ischemia compared with non-dialysis patients (11% vs. 4.5%, P<0.001). In the dialysis cohort, age ≥70 years was associated with lower extremity ischemia in univariable analysis (odds ratio [OR] 5.85; 95% confidence interval [CI] 2.08–16.4; P<0.001). ECMO use and acute coronary syndrome were not significant predictors. Multivariable analysis confirmed age ≥70 years as an independent predictor (OR 6.00; 95% CI 2.11–17.1; P<0.001). Overall, lower extremity ischemia was significantly associated with reduced 30-day survival (log-rank P<0.001). However, this association was not observed within the dialysis cohort (log-rank P=0.66, Figure). Conclusions Dialysis patients undergoing Impella support for cardiogenic shock are at increased risk of lower extremity ischemia. Advanced age (≥70 years) is an independent predictor, highlighting the need for targeted preventive strategies in elderly dialysis patients.30-day Survival