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Clinical features and outcomes in patients with cardiogenic shock complicating acute myocardial infarction: early vs recent experience with impella.

Publication ,  Journal Article
Singh, H; Mehta, RH; O'Neill, W; Kapur, NK; Lalonde, T; Ohman, M; Ghiu, I; Chen-Hsing, Y; Dutcheshen, K; Schreiber, T; Rosman, H; Kaki, A
Published in: Am Heart J
August 2021

OBJECTIVES: To compare clinical features and outcomes in patients with acute myocardial infarction complicated by cardiogenic shock (AMICS) treated in the early experience with Impella percutaneous ventricular assist device and patients treated recently. BACKGROUND: Since pre-market approval (PMA) of Impella device as treatment for AMICS, use of the device has grown considerably. METHODS: We retrospectively analyzed 649 AMICS patients treated with perioperative Impella, with 291 patients treated from 2008 to 2014 comprising the early experience cohort and 358 patients treated from 2017 to 2019 comprising the recent experience cohort. The primary end point was risk adjusted in-hospital mortality. RESULTS: Mean age and gender distribution of patients was similar in the two cohorts. The recent cohort had more invasive hemodynamic monitoring (64% vs 46%; P < .001) and less use of an intra-aortic balloon pump prior to Impella (15% vs 41%; P < .001). Recently treated patients were significantly more likely to receive Impella support prior to PCI (58% vs 44%; P = .005). In-hospital mortality was lower in the recent cohort (48% vs 56%; P = .043). This difference was however no longer significant after risk adjustment (adjusted OR 0.89, 95% CI 0.59-1.34, P = .59). Rates of acute kidney injury, major bleeding, and vascular complications requiring surgery were also significantly lower in the recent cohort. CONCLUSIONS: Use of Impella for AMICS during recent years is associated with lower unadjusted in-hospital mortality, which may reflect better patient selection, earlier device implantation, and improved management algorithms. In-depth understanding of these factors may inform the development of future treatment protocols.

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

August 2021

Volume

238

Start / End Page

66 / 74

Location

United States

Related Subject Headings

  • Vascular Diseases
  • Treatment Outcome
  • Time Factors
  • Shock, Cardiogenic
  • Retrospective Studies
  • Registries
  • Prospective Studies
  • Percutaneous Coronary Intervention
  • Odds Ratio
  • Myocardial Infarction
 

Citation

APA
Chicago
ICMJE
MLA
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Singh, H., Mehta, R. H., O’Neill, W., Kapur, N. K., Lalonde, T., Ohman, M., … Kaki, A. (2021). Clinical features and outcomes in patients with cardiogenic shock complicating acute myocardial infarction: early vs recent experience with impella. Am Heart J, 238, 66–74. https://doi.org/10.1016/j.ahj.2021.04.002
Singh, Hemindermeet, Rajendra H. Mehta, William O’Neill, Navin K. Kapur, Thomas Lalonde, Magnus Ohman, Ioana Ghiu, et al. “Clinical features and outcomes in patients with cardiogenic shock complicating acute myocardial infarction: early vs recent experience with impella.Am Heart J 238 (August 2021): 66–74. https://doi.org/10.1016/j.ahj.2021.04.002.
Singh H, Mehta RH, O’Neill W, Kapur NK, Lalonde T, Ohman M, et al. Clinical features and outcomes in patients with cardiogenic shock complicating acute myocardial infarction: early vs recent experience with impella. Am Heart J. 2021 Aug;238:66–74.
Singh, Hemindermeet, et al. “Clinical features and outcomes in patients with cardiogenic shock complicating acute myocardial infarction: early vs recent experience with impella.Am Heart J, vol. 238, Aug. 2021, pp. 66–74. Pubmed, doi:10.1016/j.ahj.2021.04.002.
Singh H, Mehta RH, O’Neill W, Kapur NK, Lalonde T, Ohman M, Ghiu I, Chen-Hsing Y, Dutcheshen K, Schreiber T, Rosman H, Kaki A. Clinical features and outcomes in patients with cardiogenic shock complicating acute myocardial infarction: early vs recent experience with impella. Am Heart J. 2021 Aug;238:66–74.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

August 2021

Volume

238

Start / End Page

66 / 74

Location

United States

Related Subject Headings

  • Vascular Diseases
  • Treatment Outcome
  • Time Factors
  • Shock, Cardiogenic
  • Retrospective Studies
  • Registries
  • Prospective Studies
  • Percutaneous Coronary Intervention
  • Odds Ratio
  • Myocardial Infarction