TCT CONNECT-184 Impact of Sex and Timing of Impella Support in Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock
Shah T, Chou J, Grines C, Chieffo A, Bellumkonda L, Sugeng L, Ghiu I, Moses J, O'Neill W, and Lansky A. TCT CONNECT-184 Impact of Sex and Timing of Impella Support in Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock. Journal of the American College of Cardiology 2020; 76(17):B78-B79.
Journal of the American College of Cardiology
Background: Randomized controlled trials studying Impella (Abiomed, Danvers, Massachusetts) usage in patients with acute myocardial infarction complicated by cardiogenic shock (AMICS) are limited. Retrospective data from the catheter-based Ventricular Assist Device Registry has demonstrated that pre-percutaneous coronary intervention (PCI) implantation of the device in AMICS patients is associated with a significant mortality benefit (odds ratio [OR]: 0.49, p = 0.04). Whether this effect varies by sex remains understudied.
Methods: In-hospital data was collected from all AMICS patients prospectively enrolled in the RECOVER III post market approval observational study of the Impella device from 2017 to 2019. Univariate logistic regression models were used to identify the effects of baseline and procedural characteristics on in-hospital mortality. Identified statistically significant predictors and sex were included in the final multivariate logistic regression model.
Results: Data were available for 82 females (41 with pre-PCI Impella vs. 41 with post-PCI Impella) and 266 males (167 pre-PCI vs. 99 post-PCI). Females had a survival benefit with Impella implantation pre-PCI compared to post-PCI (59% vs. 34%, p = 0.03); males did not (56% vs. 50%, p = 0.40). Survival for patients on 0, 1 to 2, or >2 inotropes pre-Impella was 71%, 43%, and 19% for females (p = 0.001) and 64%, 54%, and 31% for males (p = 0.004), respectively. The multivariate regression found that the following were significant independent predictors of in-hospital mortality: pre-PCI Impella implantation (OR: 0.516, p = 0.03), previously diagnosed renal insufficiency (OR: 2.482, p = 0.02), heart rate (OR: 1.013, p = 0.03), and systolic blood pressure (OR: 1.013, p = 0.03). However, sex was not an independent predictor (p = 0.59) and there was not a significant interaction between sex and pre-PCI Impella usage (p = 0.13).
Conclusion: Early implantation of Impella provides a significant survival benefit, particularly to females. Sex discrepancies appear to be the result of differing baseline and hemodynamic characteristics at presentation. Taking these factors into consideration may help identify patients most likely to benefit from Impella support.