Open AccessThe 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
Author(s) -
Pieri Marina,
Sorrentino Tania,
Oppizzi Michele,
Melisurgo Giulio,
Lembo Rosalba,
Colombo Antonio,
Zangrillo Alberto,
Pappalardo Federico
Publication year - 2018
Publication title -
journal of interventional cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.764
H-Index - 51
eISSN - 1540-8183
pISSN - 0896-4327
DOI - 10.1111/joic.12569
Subject(s) - impella , medicine , cardiogenic shock , myocardial infarction , cardiology , ejection fraction , inotrope , percutaneous coronary intervention , conventional pci , ventricular assist device , shock (circulatory) , retrospective cohort study , heart failure
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.