TCT-274 pLVAD-Supported Cardiogenic Shock in STEMI vs. NSTEMI: Does Myocardial Infarction Type Matter? Insights from RECOVER III and NCSI

Document Type

Conference Proceeding

Publication Date

10-28-2025

Publication Title

J Am Coll Cardiol

Abstract

Background: Use of Impella improves survival in patients with STEMI and cardiogenic shock (CS), however there is limited data on NSTEMI-CS. Methods: Patients with AMI-CS who underwent revascularized with Impella were included from the NCSI (NCT03677180) and RECOVER III (NCT04136392), both multi-center, single arm studies. Patients were stratified by MI type. Clinical characteristics, hemodynamics and outcomes were compared. Subgroup analyses by shock stage at time of index procedure was performed. Mortality was evaluated at discharge, 30 days and 1 year. Multivariable logistic regression adjusted for demographics, comorbidities, SCAI stage, and coronary anatomy was also performed. Results: Among 775 AMICS patients (79% STEMI, 20.3% NSTEMI]), patients with NSTEMI had more comorbidities, extensive coronary disease, and higher pre-Impella IABP use (12.7% vs. 7.3%, p=0.03). STEMI patients more often had out-of-hospital-cardiac arrest (34.8 vs. 15.5%, p<0.0001) and higher baseline lactate levels (6.3 ± 4.7 vs. 5.2 ± 4.3, p=0.06). Pre-Impella hemodynamics and use of vasoactive agents were similar between groups. Unadjusted mortality was comparable at discharge, 30 days and 1 year (p=0.71, 0.85, and 0.85, respectively), with similar outcomes across shock stages (Figure). MI type was not independently associated with survival, though STEMI trended toward higher 1-year survival (OR 0.80, 95% CI: [0.63,1.01] p=0.06). [Formula presented] Conclusion: NSTEMI patients had similar outcomes to STEMI patients, despite higher risk features when treated with Impella. Categories: CORONARY: Hemodynamic Support, Cardiogenic Shock and Cardiac Arrest

Volume

86

Issue

17

First Page

B120

Last Page

B121

Find It @ Sladen

Share

COinS