PGY-2 Internal Medicine Resident UTMB Galveston , Texas, United States
Disclosure(s):
Ayushi Sahu, DO: No financial relationships to disclose
Background: Percutaneous ventricular assist devices such as Impella are increasingly used in cardiogenic shock (CS); however, outcomes may differ based on the underlying etiology. Comparative real-world data evaluating clinical outcomes from Impella support in heart failure–related cardiogenic shock (HF-CS) versus acute myocardial infarction–related cardiogenic shock (AMI-CS) remain limited.
Methods: We conducted a retrospective cohort study using the TriNetX global federated health research network (110 healthcare organizations). Adult patients (≥18 years) hospitalized between January 1, 2019 and January 1, 2025 with cardiogenic shock who received Impella support were identified. Two cohorts were defined: HF-CS without acute myocardial infarction and AMI-CS without prior heart failure. Propensity score matching (1:1) was performed on demographics, comorbidities, medications, and laboratory variables, yielding 1,035 patients per cohort. Outcomes were assessed over one year following Impella support. The primary outcome was all-cause mortality. Secondary outcomes included cardiac arrest, acute kidney injury (AKI), ischemic and hemorrhagic stroke, rehospitalization, heart failure exacerbation, and thrombocytopenia.
Outcome: After matching, baseline characteristics were well balanced between cohorts. One-year all-cause mortality was similar between HF-CS and AMI-CS (HR 0.88, 95% CI 0.77–1.00). Rates of cardiac arrest and ischemic or hemorrhagic stroke did not differ significantly. Compared with AMI-CS, HF-CS was associated with higher risks of acute kidney injury (HR 1.59, 95% CI 1.38–1.83), rehospitalization (HR 1.43, 95% CI 1.27–1.62), heart failure exacerbation (HR 1.17, 95% CI 1.03–1.31), and thrombocytopenia (HR 2.03, 95% CI 1.60–2.58) outcomes.
Conclusion: With Impella support, overall mortality was comparable between HF-CS and AMI-CS patients. However, HF-CS was associated with substantially higher risks of renal complications, rehospitalization, heart failure exacerbation, and thrombocytopenia. These findings highlight important phenotype-specific differences in post-Impella outcomes and may inform patient selection, risk stratification, and post-discharge management strategies.
