Resident physician Wayne State University detroit, Michigan, United States
Disclosure(s):
Ishaq Khoury, MD: No financial relationships to disclose
Background: Mechanical circulatory support devices, including intra-aortic balloon pump (IABP) and Impella, are frequently used during PCI for acute myocardial infarction despite limited evidence of benefit. Current ACC/AHA/SCAI guidelines do not recommend routine use. Although Impella provides superior hemodynamic support, this has not consistently translated into improved outcomes.
Methods: We conducted a retrospective cohort study using data from the Institutional PCI Registry, including STEMI and NSTEMI patients undergoing PCI with either Impella or IABP for circulatory support at a tertiary center in Detroit, Michigan. Outcomes included in-hospital, 30-day, 6-month, and 1-year mortality, as well as acute kidney injury, cardiac arrest, and cardiogenic shock. Multivariable logistic regression adjusted for age, sex, MI type, and cardiogenic shock, with inverse probability of treatment weighting used as a sensitivity analysis.
Outcome: Among 297 patients, 229 (77%) received Impella and 68 (23%) received IABP. Impella was associated with higher in-hospital mortality compared with IABP (aOR 2.6; P=0.047) as well as higher mortality at 6 months (aOR 3.36; P=0.032). Impella use was also associated with higher rates of acute kidney injury (41.4% vs 12.3%; aOR 5.04, p< 0.001), cardiac arrest (aOR 4.03, p=0.009), and post-procedural cardiogenic shock (aOR 2.04, p=0.040). There was no statistically significant difference of MACE events.
Conclusion: In this real-world PCI registry of patients with acute myocardial infarction, Impella use was associated with higher short and intermediate-term mortality and increased peri-procedural complications. Given continued mechanical circulatory support use during high-risk PCI despite limited evidence, adequately powered randomized trials are needed to define patient selection and device choice.
