Timing of Impella implantation and outcomes in cardiogenic shock or high-risk percutaneous coronary revascularization

Francesco Burzotta, Carlo Trani, Giuseppe Tarantini, Giuliano Masiero, Gianni Lorenzoni, Giulia Masiero, Vittorio Pazzanese, Carlo Briguori, Tommaso Piva, Federico De Marco, Maurizio Di Biasi, Paolo Pagnotta, Marco Mojoli, Gavino Casu, Gennaro Giustino, Giulia Lorenzoni, Matteo Montorfano, Marco B. Ancona, Federico Pappalardo, Alaide Chieffo

Risultato della ricerca: Contributo in rivistaArticolo in rivista

Abstract

Objective: To evaluate the role of the microaxial percutaneous mechanical circulatory support device (Impella® pump) implantation pre-percutaneous coronary intervention (PCI) versus during/after PCI in cardiogenic shock (CS) and high-risk PCI populations. Background: A better understanding of the safety and effectiveness of the Impella and the role of timing of this support initiation in specific clinical settings is of utmost clinical relevance. Methods: A total of 365 patients treated with Impella 2.5/CP in the 17 centers of the IMP-IT Registry were included. Through propensity-score weighting (PSW) analysis, 1-year clinical outcomes were assessed separately in CS and HR-PCI patients, stratified by timing of Impella support. Results: Pre-procedural insertion was associated with an improvement in 1-year survival in patients with CS due to acute myocardial infarction (AMI) treated with PCI (p =.04 before PSW, p =.009 after PSW) and HR-PCI (p <.01 both before and after PSW). Among patients undergoing HR-PCI, early Impella support was also associated with a lower rate of the composite of mortality, re-hospitalization for heart failure, and need for left-ventricular assist device/heart transplantation at 1-year (p =.04 before PSW, p =.01 after PSW). Furthermore, Impella use during/after PCI was associated with an increased in-hospital life-threatening and severe bleeding among patients with AMI-CS receiving PCI (7 vs. 16%, p =.1) and HR-PCI (1 vs. 9%, p =.02). Conclusions: Our findings suggested a survival benefit and reduced rates of major bleeding when a pre-PCI Impella implantation instead of during-after procedure was used in the setting of HR-PCI and AMI-CS.
Lingua originaleEnglish
pagine (da-a)N/A-N/A
RivistaCatheterization and Cardiovascular Interventions
Volumeapr
DOI
Stato di pubblicazionePubblicato - 2021

Keywords

  • cardiogenic shock
  • mechanical cardiac support
  • left ventricular assist device
  • high-risk PCI

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