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Survival rates improved with early initiation of hemodynamic support
Patients experienced better survival rates in the setting of cardiogenic shock complicating an acute MI when hemodynamic support with the Impella 2.5 was initiated before PCI compared with after stenting.
For the study, William W. O’Neill, MD, with the Henry Ford Hospital in Detroit, and fellow researchers analyzed data from the USpella Registry on 154 consecutive patients who underwent PCI and Impella 2.5 (Abiomed) support from 38 US hospitals. The registry is an ongoing multicenter voluntary registry. Sites in the United States that have used the Impella 2.5 for all indications in more than 10 patients can participate in the registry.
O’Neill and colleagues evaluated the outcomes of patients who received hemodynamic support with Impella 2.5 before PCI vs. those who received it after the procedure, specifically regarding the incidence of cardiogenic shock complicating an acute MI. The primary endpoint for this study was survival to discharge. Assessment of patients’ hemodynamics and in-hospital complications were secondary endpoints.
William W. O’Neill
Researchers observed a higher survival rate in the patients receiving hemodynamic support before PCI (65.1%) compared with the post-PCI group (40.7%). The overall survival rate to discharge was 50.7%. In-hospital complications were found to be similar between the pre-PCI and the post-PCI groups.
According to the researchers, the use of Impella 2.5 was primarily restricted to a rescue population that failed to respond to conventional measures, including inotropic and intra-aortic balloon pump support; and although the risk for imminent death remained particularly high in this selected population, the findings suggest that the prompt use of Impella before PCI may significantly improve survival.
“Our study showed that patients who received Impella 2.5 in daily routine practice presented with greater risk features than those who were reported in recent [acute] MI [cardiogenic shock] randomized trials, reflecting a higher mortality observed in routine practice,” O’Neill and colleagues wrote.
Disclosure: The USpella Registry was supported by Abiomed. See the study for a full list of researchers’ relevant financial disclosures.