The role of different mechanical circulatory support devices and their timing of implantation on myocardial damage and mid‐term recovery in acute myocardial infarction related cardiogenic shock

Objectives Aim of the study was to assess in‐hospital survival rate and the degree of myocardial recovery after MCS treatment (IABP or IMPELLA) at discharge and at 6 months in patients with AMI‐CS and planned early percutaneous revascularization. Background All studies on MCS for acute myocardial infarction related cardiogenic shock (AMI‐CS) focused on its impact on in‐hospital mortality; however, few data about its role on myocardial recovery are available. Methods Retrospective study on 64 patients: 36 patients (56%) received IABP and 28 (44%) Impella 2.5/CP. Results Patients treated with Impella were sicker compared to those treated with IABP as shown by a higher need of catecholamines (93% Impella vs 57% IABP, P  = 0.002) and higher inotropic score before procedure: 8 (5‐15) versus 4.5 (0‐9), P  = 0.02. In‐hospital survival and MCS‐related complications were comparable; hemolysis was more frequent in the Impella group (32% vs 0%, P  < 0.0001). Myocardial damage was lower in those patients who were implanted with IMPELLA before PCI: lower troponin peak [3831 ng/dL (1441‐8436) vs 16 581 (7802‐23 675), P  = 0.004] and lower CPK peak [893 UI/L (584‐4082) vs 5797 (2483‐9292) P  = 0.04]. Impella patients had higher LVEF at 6 months [45 (38‐52) vs 40 (33‐45)%, P  = 0.04]. LVEF increase at 6 months was statistically significant in both groups ( P  < 0.0001), with higher myocardial recovery in patients supported with Impella (absolute delta‐LVEF increase 20% vs 10% P  = 0.005). Conclusions Cardiac unloading with IMPELLA in ACS‐CS, especially if implanted before PCI, might provide lower myocardial damage and improved myocardial recovery which translates into significantly higher LVEF at 6 months.