Real-life use of left ventricular circulatory support with Impella in cardiogenic shock after acute myocardial infarction: 12 years AMC experience

Abstract

Aims: Mortality in cardiogenic shock patients remains high. Short-term mechanical circulatory support with Impella can be used to support the circulation in these patients, but data from randomised controlled studies and 'real-world' data are sparse. The aim is to describe real-life data on outcomes and complications of our 12 years of clinical experience with Impella in patients with cardiogenic shock after acute myocardial infarction and to identify predictors of 6-month mortality.

Methods: We describe a single-centre registry from October 2004 to December 2016 including all patients treated with Impella for cardiogenic shock after acute myocardial infarction. We report outcomes and complications and identify predictors of 6-month mortality.

Results: Our overall clinical experience consists of 250 patients treated with Impella 2.5, Impella CP or Impella 5.0. A total of 172 patients received Impella therapy for cardiogenic shock, of which 112 patients had cardiogenic shock after acute myocardial infarction. The mean age was 60.1±10.6 years, mean arterial pressure was 67 (56-77) mmHg, lactate was 6.2 (3.6-9.7) mmol/L, 87.5% were mechanically ventilated and 59.6% had a cardiac arrest before Impella placement. Overall 30-day mortality was 56.2% and 6-month mortality was 60.7%. Complications consisted of device-related vascular complications (17.0%), non-device-related bleeding (12.5%), haemolysis (7.1%) and stroke (3.6%). In a multivariate analysis, pH before Impella placement is a predictor of 6-month mortality.

Conclusions: Our registry shows that Impella treatment in cardiogenic shock after acute myocardial infarction is feasible, although mortality rates remain high and complications occur.

Keywords: Impella; Mechanical circulatory support; acute heart failure; cardiogenic shock; percutaneous left-ventricular assist device.

Figure 1.

Flow diagram of the patients treated with Impella therapy at the Academic Medical Center, Amsterdam.

Figure 2.

Kaplan–Meier curve for patients treated with Impella for cardiogenic shock after acute myocardial infarction.

Figure 3.

Mortality at 6 months according to age, peak creatine kinase myocardial type (CKMB), pH, glucose, lactate, mean arterial blood pressure (MAP) and heart rate (HR) before Impella placement and time to return of spontaneous circulation (ROSC). Glucose, pH, lactate, MAP, HR and peak CKMB were dichotomised by dividing them into tertiles. Age was dichotomised per 10 years of age and time to ROSC by 10 minutes. Comparison between groups was made by Pearson chi-square analysis.