Association between the use of invasive hemodynamic monitoring and outcomes with percutaneous left ventricular support: A call for standardization?
Teuteberg JJ, O'Neill W. Association between the use of invasive hemodynamic monitoring and outcomes with percutaneous left ventricular support: A call for standardization? J Heart Lung Transplant. Apr 2017;36(4):S59-S59. PMID
J Heart Lung Transplant
Purpose: The Impella microaxial catheters have been approved for use in high-risk PCI and cardiogenic shock. Despite this, their use in conjunction withright heart catheterization (RHC) has not been standardized. Methods: The Impella Quality (IQ) database is a repository of over 44,000 patients from over 1000 hospitals who have had clinical use of theImpella devices maintained by Abiomed. Patients were included starting 4/1/15 and if they had at least 4 patients enrolled. The cVAD Registry is a separate and ongoing, observational multicenter registry that includes patients implanted with the Impella. Both databases were queried for concomitant use of RHC with the Impella. Results: The IQ database has 3,159 patients with acute MI (AMI) or cardiogenic shock (CGS) of whom only 1500 (47.5%) had RHC. Overall survival to explant was 51%, but was 62% in those with RHC and 48% without RHC, p< 0.0001. When thesurvival was assessed by deciles, increased use ofRHC was associated with increased survival, see Figure 1a. The cVAD Registry had 324 patients withAMI/CGS and demonstrated 30 day survival of 46% in those with RHC and 38% in those without RHC, log rank test p< 0.015, see Figure1b. Conclusion: In two large clinical databases of patients supported withan Impella in the setting of AMI/CGS an associationbetween the use of invasive hemodynamicmonitoring and improved survival has been demonstrated. While further analysis of the risk profiles of these patients is ongoing, the data suggests that invasive hemodynamic monitoringshould be utilized in conjunction with percutaneoussupport in patients with AMI/CGS (Figure presented).