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Updated: Oct 11, 2025
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Impella support for cardiogenic shock and high-risk percutaneous coronary intervention: A single-center experience
Mariana Brandão1, Daniel Caeiro1, Gustavo Pires-Morais1
1Cardiology Department, Centro Hospitalar Vila Nova de Gaia, Porto, Portugal.
Insights
The Impella® device shows promising results for high-risk percutaneous coronary intervention but has poor outcomes in cardiogenic shock patients. Further research is needed for cardiogenic shock treatment with mechanical circulatory support.
Area of Science:
- Cardiology
- Interventional Cardiology
- Mechanical Circulatory Support
Background:
- Mechanical circulatory support (MCS) use is rising for cardiogenic shock (CS) and high-risk percutaneous coronary intervention (HR-PCI).
- The Impella® device unloads the left ventricle by ejecting blood to the aorta.
Purpose of the Study:
- To report a single center's experience with the Impella® device in CS and HR-PCI.
- To evaluate the clinical and safety endpoints of Impella® use in these settings.
Main Methods:
- Single-center retrospective study.
- Included patients implanted with Impella® between 2007 and 2019 for CS or HR-PCI.
- Collected and analyzed clinical and safety data.
Main Results:
- Twelve patients treated for CS (mainly acute myocardial infarction) had high in-hospital (58.3%), 30-day (66.6%), and one-year (83.3%) mortality.
- Ten patients underwent HR-PCI with multivessel disease; in-hospital, 30-day, and one-year mortality were 10.0%, 10.0%, and 20.0%, respectively.
- Hemolysis was the most frequent complication in the CS group; no device-related deaths occurred in either group.
Conclusions:
- Impella®-supported HR-PCI outcomes were comparable to literature data.
- Outcomes for CS patients treated with Impella® were poor, with high mortality and complications.
- The Impella® device demonstrates differential effectiveness based on clinical indication.
Introduction And Objectives:
The use of mechanical circulatory support is increasing in cases of cardiogenic shock (CS) and high-risk percutaneous coronary intervention (HR-PCI). The Impella® is a percutaneous ventricular assist device that unloads the left ventricle by ejecting blood to the ascending aorta. We report our center's experience with the use of the Impella® device in these two clinical settings.
Methods:
We performed a single-center retrospective study including all consecutive patients implanted with the Impella® between 2007 and 2019 for CS treatment or prophylactic support of HR-PCI. Data on clinical and safety endpoints were collected and analyzed.
Results:
Twenty-two patients were included: 12 were treated for CS and 10 underwent an HR-PCI procedure. In the CS-treated population, the main cause of CS was acute myocardial infarction (five patients); hemolysis was the most frequent device-related complication (63.7%). In-hospital, cumulative 30-day and one-year mortality were 58.3%, 66.6% and 83.3%, respectively. In the HR-PCI group, all patients had multivessel disease (mean baseline SYNTAX I score: 44.1±13.7). In-hospital, 30-day and one-year mortality were 10.0%, 10.0% and 20.0%, respectively. There were no device- or procedure-related deaths in either group.
Conclusion:
The short- and long-term results of Impella®-supported HR-PCI were comparable to those in the literature. In the CS group, in-hospital and short-term outcomes were poor, with high mortality and non-negligible complication rates.
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