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. 2024 Feb 29;8(1):9.
doi: 10.1186/s41927-024-00380-z.

Association between Impella device support and elevated rates of gout flares: a retrospective propensity-matched study

Jorge Sinclair De Frías  1 , Shahin Isha  1 , Lorenzo Olivero  1 , Lekhya Raavi  1 , Sai Abhishek Narra  1 , Smit Paghdar  1 , Sadhana Jonna  1 , Parthkumar Satashia  1 , Rachel Hannon  1 , Jessica Blasavage  1   2 , Layton White  1 , Titilope Olanipekun  3 , Pankaj Bansal  4 , Sean Kiley  1 , Juan Carlos Leoni  5 , Jose Nativí  5 , Melissa Lyle  5 , Mathew Thomas  6 , Basar Sareyyupoglu  6 , Si Pham  6 , Michael Smith  7 , Pablo Moreno Franco  1 , Parag Patel  5 , Devang Sanghavi  8
Affiliations

Association between Impella device support and elevated rates of gout flares: a retrospective propensity-matched study

Jorge Sinclair De Frías et al. BMC Rheumatol. .

Abstract

Background: Impella is an advanced ventricular assist device frequently used as a bridge to heart transplantation. The association of Impella with increased rates of gout flares has not been studied. Our primary aim is to determine the rates of gout flares in patients on Impella support.

Methodology: A retrospective study was conducted between January 2017 and September 2022 involving all patients who underwent heart transplantation. The cohort was divided into two groups based on Impella support for statistical analysis. In patients receiving Impella support, outcome measures were compared based on the development of gout flares. 1:1 nearest neighbor propensity match, as well as inverse propensity of treatment weighted analyses, were performed to explore the causal relationship between impella use and gout flare in our study population.

Results: Our analysis included 213 patients, among which 42 (19.71%) patients were supported by Impella. Impella and non-Impella groups had similar age, race, and BMI, but more males were in the Impella group. Gout and chronic kidney disease were more prevalent in Impella-supported patients, while coronary artery disease was less common. The prevalence of gout flare was significantly higher in Impella patients (30.9% vs. 5.3%). 42 Impella-supported patients were matched with 42 patients from the non-impella group upon performing a 1:1 propensity matching. Impella-supported patients were noted to have a significantly higher risk of gout flare (30.9% vs. 7.1%, SMD = 0.636), despite no significant difference in pre-existing gout history and use of anti-gout medications. Impella use was associated with a significantly increased risk of gout flare in unadjusted (OR 8.07), propensity-matched (OR 5.83), and the inverse propensity of treatment-weighted analysis (OR 4.21).

Conclusion: Our study is the first to identify the potential association between Impella support and increased rates of gout flares in hospitalized patients. Future studies are required to confirm this association and further elucidate the biological pathways. It is imperative to consider introducing appropriate measures to prevent and promptly manage gout flares in Impella-supported patients.

Keywords: Cardiogenic shock; Circulatory failure; Gout; Hemolysis; Hemorrhage.

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Conflict of interest statement

Jessica Blasavage– Employed by Abiomed in the position of Associate Clinical Consultant. The other authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Directed acyclic graph (DAG) demonstrating interaction of various confounders with exposure (Impella use), outcome (Gout flare) and among each other
See this image and copyright information in PMC

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