Maladies cardiovasculaires et diagnostic

Concerns for the Use of Impella in Patients with Cardiogenic Shock Complicating Acute Myocardial Infarction

Abstract

Abed R, Bachoo N, Lucas CH, Nassar R and Herzog E

Introduction: To our knowledge, there has been no conclusive evidence so far to guide the choice between impella and intra-aortic balloon pump (IABP) in patients with ischemic cardiogenic shock. Using the 2016 National Inpatient Sample (NIS), this work aims to compare in-hospital outcomes among patients presenting with ischemic cardiogenic shock treated without mechanical support, with impella, or with IABP.

Methods: Data was obtained from the 2016 NIS database. The primary outcome was in-patient mortality. Secondary outcomes were hospital length of stay and total hospital charge. A series of univariate and multivariate regression analyses were conducted on STATA 15.1.

Results: In this dataset, 11710 observations met the criteria of adults, acute ischemia and cardiogenic shock. Among these, 7727 were treated without mechanical support, 649 were treated with impella, and 3,334 were treated with IABP. Patients treated with impella had higher inpatient mortality (OR 1.75; 95% CI 1.46 - 2.11), whereas patient treated with IABP had lower inpatient mortality (OR 0.77; 95% CI 0.70 - 0.85). In addition, compared with no mechanical support and IABP, the use of impella was associated with higher hospital cost (β1=198269, p<0.001). Furthermore, the use of impella was not associated with change in length of stay when compared to no mechanical support. IABP was associated with longer length of stay (β1=1.53, p<0.001).

Conclusion: In conclusion, among patients was ischemic cardiogenic shock, compared with no mechanical support, inpatient mortality was higher with impella and lower with IABP use. In addition, impella use was associated with increase hospital cost without change in hospital length of stay. Lastly, IABP was associated with increased length of stay. Despite the limitations of the NIS dataset, including selection bias, this work should prompt further research to validate the use impella.