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Outcomes of Impella compared with intra-aortic balloon pump in ST-elevation myocardial infarction complicated by cardiogenic shock

Year: 2021
Type: article
Study design: Observational Study
Abstract: Background: Despite limited randomized trial data demonstrating clinical efficacy, the utilization of Impella in ST-elevation myocardial infarction (STEMI) patients complicated with cardiogenic shock (CS) has increased over time. Methods: We identified 75,769 hospitalizations with STEMI complicated by CS between October 2015 and December 2018 using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. From this cohort, hospitalizations were stratified according to IABP or Impella placement. The primary outcome was all-cause in-hospital mortality. Secondary outcomes were divided into efficacy, safety, and device-related complications. Propensity-score matching was used to account for differences in the baseline characteristics between the groups. Logistic regression was performed to get the odds ratio and confidence intervals. Results: Among 75,769 admissions with STEMI and CS, hospitalizations with <18 years old, both IABP and Impella placement, and who underwent ECMO and/or LVAD implantation were excluded. After the exclusion, out of 72,791 admissions, 25,260 (34.70%) hospitalizations received IABP, and 7825 (10.75%) received Impella support. After propensity score-matched analysis, 7345 hospitalizations were included in each group. All-cause in-hospital mortality was higher in the hospitalizations requiring Impella support as compared to IABP (42.10% vs. 31.54%, adjusted OR 1.71; 95% confidence interval (CI) 1.60-1.84, P < 0.0001). Impella was associated with a higher risk of in-hospital complications and hospitalization cost compared with IABP. Conclusion: Impella compared with IABP in STEMI patients with CS was associated with higher in-hospital mortality and other adverse clinical and procedural outcomes.
DOI: 10.1016/j.ahjo.2021.100067
Authors: Samarthkumar Thakkar, Harsh P. Patel, Ashish Kumar, Bryan E-Xin Tan, Shilpkumar Arora, Smit Patel, Rajkumar Doshi, Jeremiah P. Depta, Ankur Kalra, Sourbha S. Dani, Abhishek Deshmukh, Apurva Badheka, Robert J. Widmer, Mamas A. Mamas, Charanjit S. Rihal, Saket Girotra, Sidakpal S. Panaich
Institutions: Rochester General Hospital, Weiss Memorial Hospital, Cleveland Clinic Akron General, Case Western Reserve University, Vassar Brothers Medical Center, University of Nevada, Reno, Unity Health System, Cleveland Clinic, Lahey Hospital and Medical Center, Lahey Medical Center, Mayo Clinic, Baylor Scott & White Medical Center - Temple, Baylor Scott & White Health, Keele University, University of Iowa, University of Iowa Health Care
Language: English
Open Access status: gold
Estimated APC paid: $2,650
OpenAlex ID: W3215926920
FWCI: 0.141
Cites: 27
Cited by: 9
Related to: 10