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Timing of Impella implantation and outcomes in cardiogenic shock or high‐risk percutaneous coronary revascularization
Author(s) -
Tarantini Giuseppe,
Masiero Giulia,
Burzotta Francesco,
Pazzanese Vittorio,
Briguori Carlo,
Trani Carlo,
Piva Tommaso,
De Marco Federico,
Di Biasi Maurizio,
Pagnotta Paolo,
Mojoli Marco,
Casu Gavino,
Giustino Gennaro,
Lorenzoni Giulia,
Montorfano Matteo,
Ancona Marco B.,
Pappalardo Federico,
Chieffo Alaide
Publication year - 2021
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.29674
Subject(s) - impella , conventional pci , medicine , cardiogenic shock , percutaneous coronary intervention , cardiology , myocardial infarction , ventricular assist device , revascularization , heart transplantation , heart failure , surgery
Objective To evaluate the role of the microaxial percutaneous mechanical circulatory support device (Impella® pump) implantation pre‐percutaneous coronary intervention (PCI) versus during/after PCI in cardiogenic shock (CS) and high‐risk PCI populations. Background A better understanding of the safety and effectiveness of the Impella and the role of timing of this support initiation in specific clinical settings is of utmost clinical relevance. Methods A total of 365 patients treated with Impella 2.5/CP in the 17 centers of the IMP‐IT Registry were included. Through propensity‐score weighting (PSW) analysis, 1‐year clinical outcomes were assessed separately in CS and HR‐PCI patients, stratified by timing of Impella support. Results Pre‐procedural insertion was associated with an improvement in 1‐year survival in patients with CS due to acute myocardial infarction (AMI) treated with PCI ( p = .04 before PSW, p = .009 after PSW) and HR‐PCI ( p < .01 both before and after PSW). Among patients undergoing HR‐PCI, early Impella support was also associated with a lower rate of the composite of mortality, re‐hospitalization for heart failure, and need for left‐ventricular assist device/heart transplantation at 1‐year ( p = .04 before PSW, p = .01 after PSW). Furthermore, Impella use during/after PCI was associated with an increased in‐hospital life‐threatening and severe bleeding among patients with AMI‐CS receiving PCI (7 vs. 16%, p = .1) and HR‐PCI (1 vs. 9%, p = .02). Conclusions Our findings suggested a survival benefit and reduced rates of major bleeding when a pre‐PCI Impella implantation instead of during‐after procedure was used in the setting of HR‐PCI and AMI‐CS.