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Updated: Nov 1, 2025
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Cardiogenic Shock Complicating Acute Myocardial Infarction Treated With Percutaneous Coronary Intervention Supported
Andrew Boshara1, Ami Patel1, Mohammad Alasaad1
1Department of Cardiology, Ascension St. John Hospital, Detroit, MI.
Insights
Impella use in cardiogenic shock shows high mortality, especially in elderly patients (≥80 years) and those in extreme shock (Stage E). Further research is needed to confirm effectiveness and resource use in these advanced cases.
Area of Science:
- Cardiology
- Medical Devices
- Acute Myocardial Infarction
Background:
- Percutaneous left ventricular mechanical circulatory support devices are increasingly used for cardiogenic shock.
- Optimal patient selection for these devices remains critical due to unclear mortality benefits.
Purpose of the Study:
- To evaluate the effectiveness of Impella Cardiac Power System in patients with cardiogenic shock due to acute myocardial infarction.
- To analyze outcomes across different cardiogenic shock stages and in elderly patient cohorts.
Main Methods:
- Retrospective review of 31 adult patients receiving Impella support.
- Data collected from January 2018 to December 2019 at a single community hospital.
- Patients categorized by Society for Cardiovascular Angiography and Intervention (SCAI) shock stages (A-E).
Main Results:
- Overall in-hospital mortality was 61%.
- Patients in SCAI Stage E (n=10) had 100% mortality.
- Mortality was higher in patients ≥80 years (86%) compared to those <80 years (54%).
- Bleeding and vascular complications occurred in 38.7% and 32.3% of patients, respectively.
Conclusions:
- Impella use in patients with advanced cardiogenic shock (Stage E) and elderly patients (≥80 years) is associated with prohibitively high mortality.
- Further prospective studies are warranted to assess Impella's effectiveness and resource utilization in these populations.
Abstract:
With percutaneous left ventricular mechanical circulatory support devices becoming increasingly available for patients with cardiogenic shock due to acute myocardial infarction and the lack of a clear mortality benefit to date, identifying optimal candidates for this technology is crucial. We studied the effectiveness of Impella Cardiac Pow (Abiomed, Danvers, MA) in various stages of cardiogenic shock and elderly cohorts.
Design:
Retrospective review.
Setting:
Data were collected for patients at a single community hospital between January 1, 2018, and December 31, 2019.
Subjects:
Thirty-one consecutive adult patients with cardiogenic shock due to acute myocardial infarction who received Impella Cardiac Pow support. Shock stages were defined by the Society for Cardiovascular Angiography and Intervention (Stages A-E).
Interventions:
None.
Measurements And Main Results:
The primary outcome was in-hospital death across Society for Cardiovascular Angiography and Intervention cardiogenic shock stages and in patients greater than or equal to 80 and less than 80 years old. Secondary outcomes were Valve Academic Research Consortium-2 vascular and bleeding complications, stroke, and renal failure requiring dialysis. The median age of the study population was 64 years, with seven patients (23%) being greater than or equal to 80 years old. No patients were in Society for Cardiovascular Angiography and Intervention Stage A, whereas there were seven in B, eight in C, six in D, and 10 (32%) in E. Overall in-hospital mortality occurred in 61% of patients. All 10 patients in Stage E died before hospital discharge. Mortality occurred in 54% of patients (13/24) age less than 80 years compared with 86% of those 80 years or older (6/7). A total of 38.7% of patients (12/31) and 32.3% of patients (10/31) experienced Valve Academic Research Consortium-2 bleeding and vascular events, which were evenly distributed across Society for Cardiovascular Angiography and Intervention cardiogenic shock Stages.
Conclusions:
In conclusion, patients with shock in extremis and those 80 years old and older may have a prohibitively high mortality despite Impella use. These findings merit further prospective investigation in a larger number of patients to evaluate the effectiveness of Impella (and other left ventricular mechanical circulatory devices) and the inherent resource utilization in advanced cardiogenic shock and the elderly.
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