Author + information
- Carsten Skurk1,
- Brunhilda Alushi2,
- Andel Douedari3,
- Ulf Landmesser4,
- Markus Florian Krackhardt5 and
- Georg Fröhlich6
- 1Department of Cardiology, Charite medical University, Campus Benjamin Franklin, Berlin, Berlin, Germany
- 2Charite Berlin, Berlin, Germany
- 3Charite, Dpt. of Cardiology, Berlin, Germany
- 4Department of Cardiology, Charité Berlin – University Medicine, Campus Benjamin Franklin, Berlin, Germany
- 5Charite University Hospital Berlin, Augustenburger Platz, Germany
- 6Charite medical University, Campus Benjamin Franklin, Berlin, Berlin, Germany
Cardiogenic shock due to acute coronary syndrome (ACS) is still associated with high mortality. Percutaneous assist devices such as the Impella® centrifugal pump provide sufficient support to stabilize hemodynamics and reduce left ventricular preload until recovery of left ventricular function. However, to date very few data comparing Impella® with former standard of care IABP are available. Therefore, the aim of our study was to determine the effects of assist devices on surrogate parameters of shock severity, early mortality and frequent causes of death in this patient population.
Consecutive cardiogenic shock patients (n=111) due to (ACS) presenting between 2011 and 2016 to two tertiary cardiac care centers were retrospectively analyzed. 51 patients underwent circulatory support with IABP and 60 with Impella. The overall mortality at 30 days was the primary outcome.
Severity of disease at baseline was higher in the Impella group as assessed by elevated SAPS II scores and lactate levels as well as reduced LVEF. However, patients receiving an Impella device had a significantly increased cardiac power index, significantly lower inotropic scores and lactate levels under therapy. The Kaplan Meier survival analysis showed no significant difference in the 30-day survival rates between the two treatment strategies (p=0.8). The most frequent cause of death in both treatment groups was cardiogenic shock with a significantly lower rate of death in the Impella vs. IABP group (20/60 (33.3 %) vs. 28/51 (54.9 %), p=0.03). Moreover, a cox regression analysis of overall mortality at 30 days showed a significant effect of Impella therapy (HR 0.45, CI 0.25-0.84, p<0.01).
Use of Impella as percutaneous assist device is protective in patients with cardiogenic shock due to ACS.
CORONARY: Hemodynamic Support and Cardiogenic Shock