Author + information
- Perwaiz M. Meraj,
- Rajkumar Doshi,
- Abhishek Vadher,
- Krunalkumar Patel and
- Bhavitha George
Acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) is associated with high in-hospital mortality and morbidity. Our goal is to check safety and efficacy of Impella (pLVAD) versus intra-aortic balloon pump (IABP) in the management of these patients.
Data was prospectively collected for total of 36,228 patients from January 2011-April 2016 from 5 hospitals in New York City. We included those patients having AMI complicated by CS (n=177). Two groups were made for each device therapy. The primary end point was in-hospital mortality and secondary outcomes were myocardial infarction, CS, stroke, heart failure, RBC transfusion, bleeding within 72 hours and new requirement of dialysis. Univariate and multivariate analysis were performed using IBM SPSS 22.0.
Patients in the IABP group had a higher mean age while patients in the Impella group had more heart failure presentation. Patients in the Impella group had significantly lower ejection fraction. After performing adjusted analysis, bleeding within 72 hours was significantly higher in the IABP cohort. No other outcome differences were noted between the groups.
In patients with AMI complicated by CS, patients with hemodynamic support with Impella prior to PCI are associated with improved survival and significantly less bleeding. The hemodynamic effect of unloading the left ventricle is a significant advantage of pLVAD.