What is the clinical evidence from this study?

Study design: Observational. Population: Acute myocardial infarction-related cardiogenic shock (AMI-CS) (n=28). Intervention: Impella 5+ (5.0/5.5). Primary outcome: Survival to hospital discharge.

What does this research mean for the field?

Impella 5+ is a safe and effective temporary mechanical circulatory support option for acute myocardial infarction-related cardiogenic shock, associated with high survival rates and a low incidence of complications. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

July 21, 2026Open Access

Clinical outcomes of Impella 5+ in acute myocardial infarction-related cardiogenic shock: a retrospective single-center study

GMG MajAzienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo APAlberto PiermartiriUniversity of Bologna SQSerena QuerioAzienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo

Key Result

Impella 5+ support in patients with acute myocardial infarction-related cardiogenic shock resulted in a 79% survival rate to hospital discharge and a low incidence of vascular complications.

Study Design

Type

Observational (n=28)

Multicenter

Structured PICO

Does Impella 5+ improve survival and provide safe mechanical circulatory support in patients with acute myocardial infarction-related cardiogenic shock?

Population

28 predominantly male patients (mean age 67 years) with acute myocardial infarction-related cardiogenic shock treated with Impella 5+ at a single center, followed to hospital discharge and up to 12 months.

Exposure

Impella 5+ (5.0/5.5) temporary mechanical circulatory support for a median length of 8 days.

Outcome

Overall survival during index hospitalizationhard clinical

Impella 5+ provides a viable and safe temporary mechanical circulatory support option for AMI-related cardiogenic shock, yielding a 79% index hospitalization survival rate with low complication rates.

Limitations

Single-center, retrospective, and observational design inherently limits causal inference and increases the risk of selection bias.
Relatively small sample size reduces statistical power and limits generalizability.
Predominantly male population limits generalizability to female patients.
Absence of a randomized control group precludes direct comparison with alternative mechanical circulatory support strategies.

Abstract

Background Temporary mechanical circulatory support (t-MCS) with Impella CP has recently attracted considerable interest as a therapeutic option for cardiogenic shock (CS) complicating acute myocardial infarction (AMI). In contrast, evidence regarding the use of the larger Impella 5+ (5.0/5.5) in this clinical setting remains limited. This single-centre retrospective study aimed to evaluate the clinical impact of Impella 5+ in patients with AMI-related cardiogenic shock (AMI-CS) Methods and results Between January 2022 and August 2024, 28 patients referred for AMI-CS were treated with Impella 5+. 11 patients were classified as SCAI C, 11 as SCAI D and 6 as SCAI E. On admission, median inotropic score was 10.5 and median left ventricular ejection fraction was 17.5%. 12 patients required concomitant ECMO support (ECPella). 19 patients were escalated from IABPM to Impella 5+. The median length of support was 8 days, 2 patients (7%) received the support for more than 30 days. 1 patient experienced a major bleeding complication. The overall survival during index hospitalization was 79%: 3 patients were bridged to a durable left ventricular assist device (LVAD) and 2 received heart transplantation (HTx). Conclusions Impella 5+ appears to be a safe and effective option in AMI-CS, associated with improved survival and a relatively low incidence of vascular and non-vascular complications. Its advanced features broaden the therapeutic potential of microaxial flow pumps in this high-risk setting.

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