TY - JOUR
T1 - Short term outcomes of Impella in cardiogenic shock
T2 - A review and meta-analysis of observational studies
AU - Iannaccone, Mario
AU - Albani, Stefano
AU - Giannini, Francesco
AU - Colangelo, Salvatore
AU - Boccuzzi, Giacomo G.
AU - Garbo, Roberto
AU - Brilakis, Emmanouil S.
AU - D'ascenzo, Fabrizio
AU - de Ferrari, Gaetano Maria
AU - Colombo, Antonio
N1 - Publisher Copyright:
© 2020 The Author(s)
PY - 2021/2/1
Y1 - 2021/2/1
N2 - Introduction: The clinical impact of invasive hemodynamic support with Impella in patients with cardiogenic shock (CS) remains to be defined. Method: Only studies including patients treated with Impella in CS were selected. The primary endpoint was short term mortality, while secondary endpoints were major vascular complications and major bleeding. Results: 17 studies and 3933 patients were included in the analysis. Median age was 61.9 (IQR 59.2–63.5) years, CS was mainly related to acute coronary syndrome (ACS): 79.6% (IQR 75.1–79.6). Thirty-day mortality was 47.8% (CI 43.7–52%). Based on metaregression analysis, the Impella 5.0 (point estimate −0.006, 95% CI -0.01 – - 0.02, p < 0.01) and the Impella CP (point estimate −0.007, 95% CI -0.01 – - 0.03, p < 0.01) devices were related to a higher survival rate, whereas the Impella 2.5 was not. Furthermore, a correlation with reduced mortality was found when Impella was initiated in CS not complicated by cardiac arrest (CA), and before revascularization, (point estimate 0.01, 95% CI 0.002–0.02, p < 0.01 and point estimate −0.02, 95% CI 0.023–0.01, p < 0.001 respectively). The vascular complication and major bleeding rate were 7.4% (95% CI 5.6–9.6%) and 15.2% (95% CI 10.7–21%) respectively, and were associated with older age and comorbidities, while the implantation of an Impella CP/2.5 L was associated with fewer complications. Conclusions: Despite the use of Impella the 30 day mortality of CS still remains high. Our data suggest that the use of an Impella CP, initiation of Impella prior to PCI and in patients without cardiac arrest was correlated with outcome improvements.
AB - Introduction: The clinical impact of invasive hemodynamic support with Impella in patients with cardiogenic shock (CS) remains to be defined. Method: Only studies including patients treated with Impella in CS were selected. The primary endpoint was short term mortality, while secondary endpoints were major vascular complications and major bleeding. Results: 17 studies and 3933 patients were included in the analysis. Median age was 61.9 (IQR 59.2–63.5) years, CS was mainly related to acute coronary syndrome (ACS): 79.6% (IQR 75.1–79.6). Thirty-day mortality was 47.8% (CI 43.7–52%). Based on metaregression analysis, the Impella 5.0 (point estimate −0.006, 95% CI -0.01 – - 0.02, p < 0.01) and the Impella CP (point estimate −0.007, 95% CI -0.01 – - 0.03, p < 0.01) devices were related to a higher survival rate, whereas the Impella 2.5 was not. Furthermore, a correlation with reduced mortality was found when Impella was initiated in CS not complicated by cardiac arrest (CA), and before revascularization, (point estimate 0.01, 95% CI 0.002–0.02, p < 0.01 and point estimate −0.02, 95% CI 0.023–0.01, p < 0.001 respectively). The vascular complication and major bleeding rate were 7.4% (95% CI 5.6–9.6%) and 15.2% (95% CI 10.7–21%) respectively, and were associated with older age and comorbidities, while the implantation of an Impella CP/2.5 L was associated with fewer complications. Conclusions: Despite the use of Impella the 30 day mortality of CS still remains high. Our data suggest that the use of an Impella CP, initiation of Impella prior to PCI and in patients without cardiac arrest was correlated with outcome improvements.
KW - Cardiogenic shock
KW - Impella
KW - Impella CP
KW - Invasive hemodynamic support
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U2 - 10.1016/j.ijcard.2020.09.044
DO - 10.1016/j.ijcard.2020.09.044
M3 - Article
C2 - 32971148
AN - SCOPUS:85091682032
SN - 0167-5273
VL - 324
SP - 44
EP - 51
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -