TCT-278 Clinical Outcomes of Patients Who Experienced Loss of Pulse Pressure During Treatment With Impella for Acute Myocardial Infarction and Cardiogenic Shock
Recommended Citation
Aurora L, Bharadwaj A, Todd J, Kaki A, Dupont A, Wohns D, Lemor A, Gorgis S, Bentley D, Jortberg E, Jin W, O’Neill W. TCT-278 Clinical Outcomes of Patients Who Experienced Loss of Pulse Pressure During Treatment With Impella for Acute Myocardial Infarction and Cardiogenic Shock. J Am Coll Cardiol 2024; 84(18):B57.
Document Type
Conference Proceeding
Publication Date
10-29-2024
Publication Title
J Am Coll Cardiol
Abstract
Background: Patients experiencing acute myocardial infarction and cardiogenic shock (AMI-CS) may become transiently dependent on Impella and experience loss of pulse pressure (LOPP). Characteristics and outcomes of such patients are unknown. Methods: Patients enrolled in the National Cardiogenic Shock Initiative with available automated Impella controller logs capturing real-time hemodynamics for the first 24 hours after Impella implantation were included. Loss of pulse pressure (LOPP) was defined as a mean pulse pressure of <10 mm Hg for ≥5 seconds while on Impella support. Patient characteristics, hemodynamics and clinical outcomes were compared between those with no episodes of LOPP vs those who experienced minimal LOPP (defined as experiencing LOPP <4.83% of time within the first 24 hours) and those who experienced sustained LOPP (defined as experiencing LOPP ≥4.83% of time within the first 24 hours). Results: There were no significant differences in baseline patient or procedural characteristics across cohorts. Pulmonary artery pulsatility index was significantly lower in those experiencing sustained LOPP compared with those with no or minimal LOPP after the procedure (P < 0.01). At 12 hours, SBPs and MAPs were lower in the LOPP subgroups (P < 0.01 for both). Those with LOPP were more likely to have an elevated lactate at 12 hours compared with those with without LOPP (P < 0.01). Survival through discharge was 86% in those who did not experience LOPP, 75% in those who experienced minimal LOPP, and 48% in those who experienced sustained LOPP (P < 0.01). Conclusions: Sustained LOPP on Impella for AMI-CS was associated with lower blood pressures, higher lactate, lower pulmonary artery pulsatility index, and lower survival. Sustained LOPP may be a marker for consideration of mechanical circulatory support (MCS) escalation or the need for more prolonged MCS duration. Categories: CORONARY: Hemodynamic Support, Cardiogenic Shock and Cardiac Arrest.
Volume
84
Issue
18
First Page
B57
