Differences in Escalation/De-Escalation and Outcomes in Cardiogenic Shock Types Supported With Impella　- Insights...

Timely initiation of temporary mechanical circulatory support (tMCS), with appropriate escalation and de-escalation strategies, is critical in managing cardiogenic shock (CS). However, how tMCS utilization and outcomes differ by CS etiology remains unclear.

Using data from the Japan Registry for Percutaneous Ventricular Assist Device (J-PVAD), we evaluated the differences in tMCS use and outcomes among 3,678 Impella-supported patients with acute myocardial infarction-related CS (AMI-CS, n=2,418 (65.7%)), de novo heart failure-related CS (de novo HF-CS, n=758 (20.6%)), and acute-on-chronic HF-related CS (acute-on-chronic HF-CS, n=502 (13.7%)). The median shock-to-support time was significantly shorter in AMI-CS (123 min) than in de novo HF-CS (186 min) and acute-on-chronic HF-CS (205 min; P<0.001 for each). De novo HF-CS patients were more likely to receive multiple tMCS (64.2%) devices compared with AMI-CS (51.4%; P<0.001) and acute-on-chronic HF-CS (55.2%; P=0.001). Compared with de novo HF-CS, the adjusted odds ratio (OR) for in-hospital death was higher in AMI-CS (OR 1.34, 95% confidence interval (CI) 1.08-1.66; P=0.008) and acute-on-chronic HF-CS (OR 1.67, 95% CI 1.25-2.22; P<0.001).

tMCS timing and utilization differed by CS type. De novo HF-CS was associated with the lowest in-hospital mortality rate.