Abstract
In selected patients with an acute myocardial infarction (AMI) complicated by Cardiogenic shock (CS), mechanical circulatory support with Impella may be beneficial, although conclusive evidence is still lacking. Nevertheless, it has been suggested that Impella initiation prior to primary PCI might improve survival. To investigate the effect pre-PCI versus immediate post-PCI Impella initiation on short term mortality. A prospective, single center, observational study, was performed including all patients with STEMI complicated by CS, treated with primary PCI and Impella. Thirty day mortality was compared between patients with Impella initiation pre-PCI and immediately post-PCI. A total of 88 patients were included. In the pre-PCI group (n = 21), admission heart rate was lower (84 versus 94 bpm, p = 0.04) and no IABP was implanted before Impella initiation, versus 17.9% in post-PCI group (n = 67), p = 0.04. Total 30-day all-cause mortality was 58%, and was lower in pre-PCI group, 47.6% versus 61.2% in the post-PCI group, however not statistically significant (HR 0.7, 95% CI 0.3-1.3, p = 0.21). Thirty-day cardiac mortality was significantly lower in the pre-PCI group, 19% versus 44.7% in the post-PCI group (HR 0.3, 95% CI 0.09-0.9...Continue Reading
References
Aug 26, 1999·The New England Journal of Medicine·J S HochmanT H LeJemtel
Jan 15, 2000·International Journal of Cardiology·F M BrunkhorstS D Anker
Apr 8, 2003·Journal of the American College of Cardiology·Bart MeynsWillem Flameng
Mar 10, 2004·Circulation·Giuseppe De LucaElliott M Antman
Jul 21, 2004·Journal of the American College of Cardiology·Rupert FinckeUNKNOWN SHOCK Investigators
Sep 27, 2007·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Maurice RemmelinkJan Baan
Feb 6, 2008·Circulation·Harmony R Reynolds, Judith S Hochman
Nov 15, 2008·Journal of the American College of Cardiology·Melchior SeyfarthAlbert Schömig
Feb 25, 2009·Circulation·Robert J GoldbergJorge Yarzebski
Nov 27, 2009·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Maurice RemmelinkJan Baan
Jul 25, 2012·Heart·Dagmar M Ouweneel, José P S Henriques
Aug 28, 2012·The New England Journal of Medicine·Holger ThieleUNKNOWN IABP-SHOCK II Trial Investigators
Dec 6, 2012·Circulation. Heart Failure·Alexander LautenMarkus Ferrari
Dec 22, 2012·Journal of the American College of Cardiology·Patrick T O'GaraDavid X Zhao
Jun 15, 2013·Circulation·Navin K KapurRichard H Karas
Jan 15, 2014·Journal of the American Heart Association·Dhaval KolteGregg C Fonarow
Mar 31, 2015·International Journal of Cardiology·B RedforsE Omerovic
Nov 7, 2015·JACC. Heart Failure·Navin K KapurRichard H Karas
May 28, 2016·Journal of Interventional Cardiology·Susan M JosephUNKNOWN genVAD Working Group
Nov 5, 2016·Journal of the American College of Cardiology·Dagmar M OuweneelJosé P S Henriques
Jan 4, 2017·The American Journal of Cardiology·Mir B BasirWilliam W O'Neill
Sep 10, 2017·European Heart Journal·Borja IbanezUNKNOWN ESC Scientific Document Group
Nov 18, 2017·European Heart Journal. Acute Cardiovascular Care·Peter Blom JensenJacob Eifer Møller
Dec 22, 2017·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Mir B BasirWilliam W O'Neill Md
May 29, 2018·American Heart Journal·William W O'NeillE Magnus Ohman
Dec 28, 2018·Circulation·Navin K KapurWilliam W O'Neill
Dec 28, 2018·Circulation·Richard ChocronUNKNOWN Paris SDEC Investigators
Dec 28, 2018·Circulation·Benedikt SchrageDirk Westermann
Jun 9, 2019·American Heart Journal·Nanna Junker UdesenUNKNOWN DanGer Shock investigators
Nov 19, 2019·Circulation·Amit P AminSunil V Rao
Dec 8, 2019·Netherlands Heart Journal : Monthly Journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation·D I M van DortG S C Geuzebroek