Outcomes of mechanical circulatory support for acute myocardial infarction complicated by cardiogenic shock

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Updated: Nov 1, 2025

Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
06:10

Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock

Published on: June 12, 2021

3.4K

Yeunjung Kim1, Kayle Shapero2, Shawn S Ahn3

  • 1Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|June 22, 2021
PubMed

Insights

Mechanical circulatory support (MCS) with Impella devices showed increased in-hospital mortality and costs compared to intra-aortic balloon pumps (IABP) in acute myocardial infarction with cardiogenic shock (AMICS) patients. Further randomized trials are needed to confirm safety and efficacy.

Area of Science:

  • Cardiology
  • Medical Devices
  • Health Outcomes Research

Background:

  • Mechanical circulatory support (MCS) is used in acute myocardial infarction with cardiogenic shock (AMICS).
  • Previous data suggested higher in-hospital mortality with Impella devices compared to intra-aortic balloon pumps (IABP).

Purpose of the Study:

  • To describe trends and outcomes of Impella usage in AMICS patients treated with MCS.
  • To compare in-hospital mortality, transfusion rates, acute kidney injury, stroke, costs, and length of stay between Impella and IABP.

Main Methods:

  • Retrospective cohort study using the National Inpatient Sample (NIS) from 2012-2017.
  • Included hospitalizations for AMICS managed with MCS (Impella or IABP).
  • Propensity score matching was performed to adjust for confounders.

Main Results:

  • Impella usage increased from 10.5% to 19.9% of AMICS cases between 2012 and 2017.
  • After matching, Impella was associated with higher in-hospital mortality (OR 1.74) and transfusion rates (OR 1.97) than IABP.
  • Impella use resulted in significantly higher hospital costs (mean difference $22,416.80).

Conclusions:

  • Impella use in AMICS has increased significantly and is linked to higher in-hospital mortality and costs.
  • No significant association was found with acute kidney injury or stroke.
  • Randomized controlled trials are essential to evaluate Impella's safety and efficacy in AMICS.
Abstract

Keywords:
ECMO/IABP/tandem/impellaacute myocardial infarction/STEMIcardiogenic shockmechanical circulatory support

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