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Related Experiment Video

Updated: Oct 26, 2025

Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
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Complete Revascularisation in Impella-Supported Infarct-Related Cardiogenic Shock Patients Is Associated With

Andreas Schäfer1, Ralf Westenfeld2, Jan-Thorben Sieweke1

  • 1Department of Cardiology and Angiology, Cardiac Arrest Center, Hannover Medical School, Hanover, Germany.

Frontiers in Cardiovascular Medicine
|July 26, 2021
PubMed
Summary

Complete revascularization with Impella support before percutaneous coronary intervention (PCI) may lower mortality in acute myocardial infarction-related cardiogenic shock (AMI-CS) patients. This strategy shows better outcomes than incomplete revascularization or post-PCI Impella implantation.

Keywords:
acute heart failurecardiogenic shockmicroaxial flow-pumpsmyocardial infarctionrevascularisation

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Critical Care Medicine

Background:

  • Acute myocardial infarction-related cardiogenic shock (AMI-CS) has a high in-hospital mortality rate.
  • Previous trials showed no benefit of routine intra-aortic balloon pump use in AMI-CS.
  • The CULPRIT-SHOCK trial found no benefit of multivessel vs. culprit-lesion only revascularization in AMI-CS, with limited mechanical circulatory support use.

Purpose of the Study:

  • To test the hypothesis that complete revascularization facilitated by Impella support reduces mortality in AMI-CS patients.
  • To evaluate the impact of Impella implantation timing and revascularization completeness on outcomes in AMI-CS.

Main Methods:

  • Retrospective analysis of 202 consecutive Impella-treated AMI-CS patients from four European high-volume shock centers.
  • Patients with cardiac arrest before Impella implantation: 47%.
  • Incomplete revascularization defined as residual SYNTAX-score (rS) > 8.

Main Results:

  • Overall 30-day mortality was 47%.
  • Higher mortality observed with post-PCI Impella implantation (57%) versus pre-PCI (38%) and with incomplete revascularization (rS > 8: 56%) versus complete (rS ≤ 8: 37%).
  • Patients receiving Impella pre-PCI with complete revascularization had significantly lower mortality (33%) compared to those with incomplete revascularization and post-PCI Impella (72%).

Conclusions:

  • Complete revascularization supported by Impella implanted prior to PCI is associated with lower mortality in AMI-CS patients.
  • This retrospective analysis suggests a potential benefit of early Impella support combined with complete revascularization in managing AMI-CS.