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Timing of Impella CP® (ABIOMED, Danvers) heart pump initiation relative to the start of a percutaneous coronary intervention (PCI) has never been studied in the context of acute myocardial infarction complicated by cardiogenic shock (AMICS).
We reviewed retrospectively all consecutive adult patients supported between Jan 2014 and Dec 2016 with Impella CP heart pump for CS at our institution. We compared the survival to explant, discharge and 180 days between patients who received Impella CP prior to the start of the PCI (Pre-PCI group) and those who received it after the start of the PCI (Post-PCI group).
A total of 100 consecutive patients were supported with Impella CP for CS. Of those 73 underwent PCI for AMICS (34 Pre-PCI vs. 39 Post-PCI). Age was 69±12 years, 27% female, 66% presented with STEMI and 59% sustained cardiac arrest. Pre-PCI patients were older (72.4±9.2 vs. 65.9±14.0, p=0.02), had more diabetes (53%vs.26%, p=0.03), more diseased vessels (2.62±0.55 vs 2.20±0.82, p=0.009), higher Glasgow Coma Score (7.7±5.6 vs. 4.7±4.0, p=0.01) and more left main culprit (41%vs.18%, p=0.009). Post-PCI patients were more often mechanically ventilated (64%vs.87%, p=0.03) and had higher serum lactate (7.5±6.1 vs. 4.9±3.6, p=0.03) at baseline. Pre-PCI group had more lesions treated (2.1±0.9 vs. 1.6±1.0, p= 0.03), higher survival to explant (65%vs.31%, p=0.005) and higher survival to discharge (50%vs.23%, p=0.03) and to 180 days.
Impella CP initiation prior to PCI is associated with significantly better survival at discharge, 30 days and 180 days in patients with AMI complicated by CS
CORONARY: Hemodynamic Support and Cardiogenic Shock