TCT CONNECT-172 Clinical Features and Outcomes of Acute Myocardial Infarction and Cardiogenic Shock Patients Treated With Impella: Early Compared With Recent Experience
Singh H, Mehta R, O'Neill W, Lalonde T, Ghiu I, Chen-Hsing Y, Dutcheshen K, Schreiber T, and Rosman H. TCT CONNECT-172 Clinical Features and Outcomes of Acute Myocardial Infarction and Cardiogenic Shock Patients Treated With Impella: Early Compared With Recent Experience. Journal of the American College of Cardiology 2020; 76(17):B74.
Journal of the American College of Cardiology
Background: The percutaneous ventricular assist device, Impella (Abiomed, Danvers, Massachusetts), received U.S. Food and Drug Administration pre-market approval (PMA) for treatment of patients with acute myocardial infarction and cardiogenic shock (AMICS) on April 7, 2016. The purpose was to compare the clinical features and outcomes of early (pre-PMA) versus recent (post-PMA) Impella use in AMICS.
Methods: We performed a retrospective analysis on 649 AMICS patients (291 early (December 20, 2008, to June 23, 2014) and 358 recent (January 8, 2017, to August 29, 2019) enrolled in catheter-based ventricular assist devices registry treated with Impella either before or after percutaneous coronary intervention (PCI). The primary endpoint was risk adjusted in-hospital mortality.
Results: Mean age of patients was similar in early versus recent periods (65 ± 12 and 64 ± 11 years, respectively). The prevalence of hypertension, smoking, stroke, and New York Heart Association functional class III/IV CHF were higher and anoxic brain injury lower in recent group. Recent cohort also had more invasive hemodynamic monitoring and lesser use of intra-aortic balloon pump. The time to Impella from shock onset was shorter and duration of support longer in recent patients who were also more likely to have the device implanted pre-PCI. Incidence of peri-PCI AKI, major bleeding or vascular complications were lower in the recent cohort. Observed in-hospital mortality was also lower in recent group (48% vs. 56%, p = 0.043) and showed similar trends favoring recent group for all subgroups examined. This difference was significantly attenuated after risk adjustment (adjusted odds ratio: 0.89; 95% confidence interval: 0.59 to 1.34; p = 0.59).
Conclusion: The use of Impella in recent years was associated with lower observed in-hospital mortality that was mostly related to patients’ comorbid conditions suggesting better selection in addition to changes in processes of care of these patients. In-depth understanding of the factors associated with lower mortality has the potential to improve outcomes of AMICS patients receiving Impella in community at large.