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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Percutaneous coronary intervention with Impella support with and without intra-aortic balloon in cardiogenic shock
Refayat Bhuiyan1, Tia Bimal1, Joanna Fishbein2
1Mather Hospital, Port Jefferson, NY, United States of America.
Insights
In patients with cardiogenic shock undergoing percutaneous coronary intervention, using Impella alone or with an intra-aortic balloon pump (IABP) resulted in similar high rates of major adverse cardiac and cerebrovascular events (MACCE) and bleeding complications. Access site bleeding was lower with dual mechanical circulatory support (MCS).
Area of Science:
- Cardiology
- Interventional Cardiology
- Mechanical Circulatory Support
Background:
- Cardiogenic shock (CS) is a life-threatening condition often requiring mechanical circulatory support (MCS) during percutaneous coronary intervention (PCI).
- Impella and intra-aortic balloon pump (IABP) are commonly used MCS devices, with varying strategies for their combined use in high-risk PCI patients.
Purpose of the Study:
- To compare clinical characteristics, in-hospital bleeding, and major adverse cardiac and cerebrovascular events (MACCE) between Impella alone and combined Impella-IABP support in CS patients undergoing PCI.
- To evaluate the safety and efficacy of dual MCS (Impella and IABP) versus Impella alone in this high-risk patient population.
Main Methods:
- Retrospective analysis of 101 CS patients undergoing PCI treated with Impella alone or dual MCS (Impella and IABP) between 2010-2018.
- Bleeding complications were assessed using a modified Bleeding Academic Research Consortium (BARC) classification.
- MACCE was defined as a composite of in-hospital death, myocardial infarction, cerebrovascular events, and major bleeding.
Main Results:
- Dual MCS patients more frequently presented with STEMI and underwent left main coronary artery intervention.
- Major bleeding complications (69.4% vs. 74.1%) and MACCE rates (80.6% vs. 79.3%) were high and similar between Impella alone and dual MCS groups.
- Access site bleeding complications were significantly lower in the dual MCS group (5.0% vs. 24.6%). In-hospital mortality was comparable (29.5% vs. 25.0%).
Conclusions:
- In CS patients undergoing PCI, Impella alone or combined with IABP showed similar rates of major bleeding and MACCE, despite differences in baseline characteristics.
- Dual MCS demonstrated a significant reduction in access site bleeding complications.
- Further research is warranted to elucidate the optimal use of simultaneous MCS in CS patients undergoing PCI.
Objective:
To assess the clinical characteristics and in-hospital bleeding complications and major adverse cardiac and cerebrovascular events (MACCE) associated with the use of Impella alone or the combination of an intra-aortic balloon pump (IABP) with Impella in cardiogenic shock (CS) patients undergoing percutaneous coronary intervention (PCI).
Methods:
All CS patients who underwent PCI and were treated with an Impella mechanical circulatory support (MCS) device were identified. Patients were divided into two groups: having MCS support with Impella alone or with both, IABP and Impella simultaneously (dual MCS group). Bleeding complications were classified by a modified Bleeding Academic Research Consortium (BARC) classification. Major bleeding was defined as BARC≥3 bleeding. MACCE was the composite of in-hospital death, myocardial infarction, cerebrovascular events and major bleeding complications.
Results:
Between 2010 and 2018 a total of 101 patients were treated at six tertiary care New York hospitals with either Impella (n = 61) or dual MCS with Impella and IABP (n = 40). Clinical characteristics were similar for both groups. Dual MCS patients presented more often with a STEMI (77.5 % vs. 45.9 %, p = 0.002) and had left main coronary artery intervention (20.3 % vs. 8.6 %, p = 0.03). Major bleeding complications (69.4 % vs. 74.1 %, p = 0.62) and MACCE rates (80.6 % vs. 79.3 %, p = 0.88) were very high but similar in both groups, however access site bleeding complications were lower in patients treated with dual MCS. In-hospital mortality was 29.5 % for the Impella group and 25.0 % for the dual MCS group (p = 062). Access site bleeding complications were lower in in patients treated with dual MCS (5.0 % vs. 24.6 %, p = 0.01).
Conclusion:
In CS patients undergoing PCI with either the Impella device alone or with Impella and IABP, major bleeding complications and MACCE rates were high but not significantly different between the two groups. In hospital mortality was relatively low in both MCS groups despite the high-risk characteristics of these patients. Future studies should assess the risks and benefits of the simultaneous use of these two MCS in CS patients undergoing PCI.
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