RT Journal Article
SR Electronic
T1 Impella versus IABP in acute myocardial infarction complicated by cardiogenic shock
JF Open Heart
JO Open Heart
FD British Cardiovascular Society
SP e000987
DO 10.1136/openhrt-2018-000987
VO 6
IS 1
A1 Brunilda Alushi
A1 Andel Douedari
A1 Georg Froehlig
A1 Wulf Knie
A1 Thomas H Wurster
A1 David M Leistner
A1 Barbara-Elisabeth Staehli
A1 Hans-Christian Mochmann
A1 Burkert Pieske
A1 Ulf Landmesser
A1 Florian Krackhardt
A1 Carsten Skurk
YR 2019
UL http://openheart.bmj.com/content/6/1/e000987.abstract
AB 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.