A study published in the Journal of Interventional Cardiology indicates that the use of the Impella 2.5 heart pump (Abiomed) is associated with a significant survival benefit in patients with acute myocardial infarction and cardiogenic shock when inserted prior to percutaneous coronary intervention (PCI).
Perwaiz Meraj (Department of Cardiology, Northwell Health, Manhasset, USA) and colleagues performed a retrospective review of 36 patients, from 19 US sites participating in the cVAD Registry, who received haemodynamic support with the Impella 2.5 heart pump. The aim was to assess if the initiation of haemodynamic support before PCI (20 patients) would have a survival benefit compared to the initiation of support after PCI (16 patients). The majority of these patients (average age 69) were in cardiogenic shock at the time of hospital admission (73%) and had a low mean ejection fraction of 25%. For all patients, the culprit lesion was in the unprotected left main coronary artery (ULMCA).
The investigators found that initiating support prior to PCI was associated with increased survival at discharge (55% vs. 19% for after PCI; p=0.041) and at 30 days (48% vs. 13%, respectively; p=0.004). Meraj comments: “Patients with cardiogenic shock complicating an acute myocardial infarction due to an unprotected left main coronary artery culprit lesion are some of the sickest and most clinically challenging patients admitted in the cath lab. Our data suggest that early placement of Impella before PCI is vital to survival.”
A press release reports that patients supported with the Impella 2.5 heart pump post-PCI appear to have very poor survival at 30 days. However, it says that this study adds to the existing body of clinical data supporting the early placement of Impella heart pumps before PCI for patients in cardiogenic shock. The press release notes that additional data from Abiomed’s observational IQ database of 15,259 patients with acute myocardial infarction and cardiogenic shock and data from the Detroit Cardiogenic Shock Initiative reinforce the best practice of placing Impella heart pump before PCI in cardiogenic shock patients.