Impella use in patients with AMI-CS undergoing PCI was associated with significantly higher mortality (42.3% vs. 35.7%; p=0.02) and major bleeding compared to vasopressors without MCS.
Cohort (n=17,762)
Yes
Absolute Event Rate: 42.3% vs 35.7%
p-value: p=0.02
BACKGROUND: Previous studies have compared Impella use to intra-aortic balloon pump (IABP) use in patients with acute myocardial infarction and cardiogenic shock (AMI-CS) undergoing percutaneous coronary intervention (PCI). Our objective was to compare clinical outcomes in patients with AMI-CS undergoing PCI who received Impella (percutaneous left ventricular assist device) without vasopressors, IABP without vasopressors, and vasopressors without mechanical circulatory support (MCS). METHODS: We queried the National Inpatient Sample (NIS) using ICD-10 codes (2015-2018) to identify patients with AMI-CS undergoing PCI. We created three propensity-matched cohorts to examine clinical outcomes in patients receiving Impella versus IABP, Impella versus vasopressors without MCS, and IABP versus vasopressors without MCS. RESULTS: Among 17,762 patients, Impella use was associated with significantly higher in-hospital major bleeding (31.4% vs. 13.6%; p < 0.001) and hospital charges (p < 0.001) compared to IABP use, with no benefit in mortality (34.1% vs. 26.9%; p = 0.06). Impella use was associated with significantly higher mortality (42.3% vs. 35.7%; p = 0.02), major bleeding (33.9% vs. 22.7%; p = 0.001), and hospital charges (p < 0.001), when compared to the use of vasopressors without MCS. There were no significant differences in clinical outcomes between IABP use and the use of vasopressor without MCS. CONCLUSIONS: In this analysis of retrospective data of patients with AMI-CS undergoing PCI, Impella use was associated with higher mortality, major bleeding, and in-hospital charges when compared to vasopressor therapy without MCS. When compared to IABP use, Impella was associated with no mortality benefit, along with higher major bleeding events and in-hospital charges. A vasopressor-only strategy suggested no difference in clinical outcomes when compared to IABP. This study uses the NIS for the first time to highlight outcomes in AMI-CS patients undergoing PCI when treated with vasopressor support without MCS, compared to Impella and IABP use.
Javaid et al. (Thu,) conducted a cohort in Acute myocardial infarction and cardiogenic shock (AMI-CS) (n=17,762). Impella (percutaneous left ventricular assist device) vs. Intra-aortic balloon pump (IABP) or vasopressors without mechanical circulatory support was evaluated on Mortality (Impella vs. vasopressors without MCS) (p=0.02). Impella use in patients with AMI-CS undergoing PCI was associated with significantly higher mortality (42.3% vs. 35.7%; p=0.02) and major bleeding compared to vasopressors without MCS.