Author + information
- Shailendra Singh,
- Yonathon Litwok,
- Evelina Grayver,
- Stacey Rosen and
- Alexander Lee
Background: Acute MI (AMI) complicated by cardiogenic shock (CS) continues to yield a devastating challenge with high mortality rates. Hemodynamic stabilization before and/or after early revascularization remains the primary goal in these patients. In addition to hemodynamic support by inotropes and vasopressors, support with percutaneous mechanical circulatory support devices such as intra-aortic balloon pumping (IABP), and percutaneous left ventricular assist devices (LVAD- e.g. Impella) have become an integral component to cardiovascular treatment options.
Methods: We performed a retrospective, multi-center observational study of 72 consecutive patients (58 men, 14 women) who presented with refractory CS from January 2012 to July 2016. All patients were found to be in refractory CS and taken to the cardiac catheterization laboratory for mechanical support implantation.
Results: There was a statistically significant decrease in time of presentation to device implantation or “LV unloading,” which has consistently decreased with significance from 2013 to present day. In order to establish a baseline for admission hemodynamics, we determined that all incoming patients in all years had similarly elevated initial LVEDP, CK-MB, and Troponin T. By decreasing the time interval to Impella support, we also found improved survival. Patients who had Impella support placed earlier in their presentation were found to have quicker hemodynamic improvement, decreased infarct-size and decreased length of stay. Patients in 2016 who were found to have improved cardiovascular outcomes were also found to have a shorter duration of mechanical support.
Conclusions: The present study demonstrates the fact that earlier implantation of Impella support in AMI complicated by refractory CS improved early hemodynamics leading to rapid decrease in pressor/ionotropes support, with improved cardiovascular outcomes and shortened hospital length of stay. We strongly believe that earlier LV unloading with Impella support may prevent LV remodeling and decrease cardiac work which was associated with several advantages.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Coronary Intervention in Interventional Cardiology: Advanced Device Use
Abstract Category: 21. Interventional Cardiology: Coronary Intervention: Devices
Presentation Number: 1155-163
- 2017 American College of Cardiology Foundation