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Original research article
Impella versus IABP in acute myocardial infarction complicated by cardiogenic shock
  1. Brunilda Alushi1,
  2. Andel Douedari1,
  3. Georg Froehlig1,
  4. Wulf Knie1,
  5. Thomas H Wurster1,
  6. David M Leistner2,
  7. Barbara-Elisabeth Staehli2,
  8. Hans-Christian Mochmann2,
  9. Burkert Pieske3,
  10. Ulf Landmesser1,
  11. Florian Krackhardt4 and
  12. Carsten Skurk2
  1. 1 Department of Cardiology, Charite Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
  2. 2 Department of Cardiology, University Heart Center Berlin and Charite University Medicine Berlin, Campus Benjamin-Franklin, Berlin, Germany
  3. 3 Department of Internal Medicine and Cardiology, Charité University Medicine, Berlin, Germany
  4. 4 Department of Cardiology (CVK), Charité University Medicine, Berlin, Germany
  1. Correspondence to Dr Carsten Skurk; carsten.skurk{at}charite.de

Abstract

Objective We investigated the benefit of Impella, a modern percutaneous mechanical support (pMCS) device, versus former standard intra-aortic balloon pump (IABP) in acute myocardial infarction complicated by cardiogenic shock (AMICS).

Methods This single-centre, retrospective study included patients with AMICS receiving pMCS with either Impella or IABP. Disease severity at baseline was assessed with the IABP-SHOCK II score. The primary outcome was all-cause mortality at 30 days. Secondary outcomes were parameters of shock severity at the early postimplantation phase. Adjusted Cox proportional hazards models identified independent predictors of the primary outcome.

Results Of 116 included patients, 62 (53%) received Impella and 54 (47%) IABP. Despite similar baseline mortality risk (IABP-SHOCK II high-risk score of 18 % vs 20 %; p = 0.76), Impella significantly reduced the inotropic score (p < 0.001), lactate levels (p < 0.001) and SAPS II (p = 0.02) and improved left ventricular ejection fraction (p = 0.01). All-cause mortality at 30 days was similar with Impella and IABP (52 % and 67 %, respectively; p = 0.13), but bleeding complications were more frequent in the Impella group (3 vs 4 units of transfused erythrocytes concentrates due to bleeding complications, p = 0.03). Previous cardiopulmonary resuscitation (HR 3.22, 95% CI 1.76 to 5.89; p < 0.01) and an estimated intermediate (HR 2.77, 95% CI 1.42 to 5.40; p < 0.01) and high (HR 4.32 95% CI 2.03 to 9.24; p = 0.01) IABP-SHOCK II score were independent predictors of all-cause mortality.

Conclusions In patients with AMICS, haemodynamic support with the Impella device had no significant effect on 30-day mortality as compared with IABP. In these patients, large randomised trials are warranted to ascertain the effect of Impella on the outcome.

  • impella
  • IABP
  • cardiogenic shock
  • mechanical support
  • myocardial infarction

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • FK and CS contributed equally.

  • Contributors BA, CS and FK designed and implemented the study, supervised the statistical analysis and drafted the final manuscript; AD, GF, WK, TW, CM collected the data; LD, ES, BP and UL critically revised the manuscript.

  • CONFLICT OF INTEREST STATEMENT Dr Carsten Skurk has perceived lecturer fees from Abiomed, outside the submitted work. Dr Landmesser reports grants from Edwards Lifesciences, grants and personal fees from Abbott, outside the submitted work. All other authors report no relationships relevant to the contents of this paper to disclose.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data relevant to the study are included in the article or uploaded as supplementary information.

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