26-A-9362-ACC Timing of Impella Implantation after Ecmo in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Recommended Citation
Doma M, Ramadan A, Saavedra AG, Jabri A, Atta R, Megaly M, Basir MB, Goldsweig AM, Villablanca PA. 26-A-9362-ACC Timing of Impella Implantation after Ecmo in Acute Myocardial Infarction Complicated by Cardiogenic Shock. J Am Coll Cardiol 2026; 87(13):A680.
Document Type
Conference Proceeding
Publication Date
4-7-2026
Publication Title
J Am Coll Cardiol
Abstract
Background: Extracorporeal membrane oxygenation (ECMO) can stabilize hemodynamics in acute myocardial infarction complicated by cardiogenic shock (AMI-CS). Impella for left ventricular venting may improve myocardial recovery, but optimal Impella implantation timing remains unknown. Methods: Using the TriNetX Research Network, we identified 1273 patients with AMI-CS supported with ECMO between 2015 and 2025. Propensity score matching to study Impella timing after ECMO yielded 242 pairs for same-day vs. 1 day, 185 pairs for same-day vs. 2 days, 151 pairs for same-day vs. 3 days, 181 pairs for 1 vs. 2 days, 150 pairs for 1 vs. 3 days, and 149 pairs for 2 vs. 3 days. Cox proportional hazard models estimated hazard ratios (HRs) with 95% confidence intervals (CIs). Results At 1 month, same-day Impella implantation was associated with a higher incidence of acute kidney injury compared with day 2 (HR 1.44; 95% CI 1.07-1.94) or day 3 implantation (HR 1.41; 95% CI 1.02-1.96). At 6 months and 1 year, same-day implantation was associated with a higher risk of all-cause hospitalization compared with day 2 implantation (HR 1.35; 95% CI 1.01-1.82) and (HR 1.34; 95% CI 1.02-1.80), respectively. No significant differences were observed in all-cause mortality (Figure), stroke, or peripheral limb ischemia. Conclusion: In patients with AMI-CS on ECMO, Impella implantation anytime within the first 3 days was not associated with significant differences in long-term mortality or major
Volume
87
Issue
13
First Page
A680
