Cardiogenic shock etiology and exit strategy impact survival in patients with Impella 5.5

Author:

Sicke McKenzie1ORCID,Modi Shan2,Hong Yeahwa3,Bashline Michael4ORCID,Klass Wyatt4,Horn Ed5,Hansra Barinder S24,Ramanan Raj2ORCID,Fowler Jeffrey4,Sumzin Nikita6,Rivosecchi Ryan M5,Chaudhary Rahul4,Ziegler Luke A4,Hess Nicholas R7,Agrawal Nishant1,Kaczorowski David J7,Hickey Gavin W4

Affiliation:

1. University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

2. Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

3. Department of Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, PA, USA

4. Division of Cardiology Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

5. Department of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA

6. Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

7. Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA USA

Abstract

Background: Despite historical differences in cardiogenic shock (CS) outcomes by etiology, outcomes by CS etiology have yet to be described in patients supported by temporary mechanical circulatory support (MCS) with Impella 5.5. Objectives: This study aims to identify differences in survival and post-support destination for these patients in acute myocardial infarction (AMI) and acute decompensated heart failure (ADHF) CS at a high-volume, tertiary, transplant center. Methods: A retrospective review of patients who received Impella 5.5 at our center from November 2020 to June 2022 was conducted. Results: Sixty-seven patients underwent Impella 5.5 implantation for CS; 23 (34%) for AMI and 44 (66%) for ADHF. AMI patients presented with higher SCAI stage, pre-implant lactate, and rate of prior MCS devices, and fewer days from admission to implantation. Survival was lower for AMI patients at 30 days, 90 days, and discharge. No difference in time to all-cause mortality was found when excluding patients receiving transplant. There was no significant difference in complication rates between groups. Conclusions: ADHF-CS patients with Impella 5.5 support have a significantly higher rate of survival than patients with AMI-CS. ADHF patients were successfully bridged to heart transplant more often than AMI patients, contributing to increased survival.

Publisher

SAGE Publications

Subject

Biomedical Engineering,Biomaterials,General Medicine,Medicine (miscellaneous),Bioengineering

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