SPC365

Real-world Insights: Practical Impella Outcomes in Cardiogenic Shock and High-risk elective percutaneous coronary intervention

Session: Sessão de Posters 04 - Choque cardiogénico
Speaker: Mariana Martinho

Congress: CPC 2024
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 14. Acute Cardiac Care
Subtheme: 14.4 Acute Cardiac Care – Cardiogenic Shock
Session Type: Cartazes
FP Number: ---
Authors: Mariana Martinho; Bárbara Marques Ferreira; Rita Calé; Diogo Santos Cunha; Oliveira Baltazar; Nazar Ilchyshyn; João Mirinha Luz; Pedro Santos; Ana Rita Pereira; Gonçalo Morgado; Cristina Martins; Hélder Pereira

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:Helvetica"><span style="color:#404040">Introduction: </span></span></span></strong><span style="font-size:10.0pt"><span style="font-family:Helvetica"><span style="color:#404040">Cardiogenic shock (CS) complicates 5-10% of all acute coronary syndromes (ACS), with an in-hospital mortality of approximately&nbsp;40%. The use of Impella</span></span></span><span style="font-size:10.0pt"><span style="font-family:Helvetica"><span style="color:#404040">&nbsp;in elective high-risk coronary intervention appears to reduce procedure-related mortality. Given its capacity to rapidly unload the left ventricle and increase cardiac output, it has been posited as a potential short-term mechanical circulatory support system in CS. However, conflicting evidence exists regarding the&nbsp;advantageous aspects of its application. Furthermore, some studies suggest delayed weaning may improve outcomes, but&nbsp;further investigation is necessary to determine the impact of removal timing on patient (pt) outcomes and device-associated complications.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><strong><span style="font-size:10.0pt"><span style="font-family:Helvetica"><span style="color:#404040">Methods: </span></span></span></strong><span style="font-family:Calibri,sans-serif; font-size:10pt"><span style="font-family:Helvetica"><span style="color:#404040">Retrospective observational single-center study of consecutive pts&nbsp;undergoing Impella CP</span></span></span><span style="font-size:10pt"><span style="color:#404040"><span style="font-family:Helvetica">&nbsp;device insertion, between 2021 and 2023. Two patient groups were established, depending on being admitted for scheduled angioplasty, or device insertion due to CS (either CS on admission, or intraprocedural impending CS). Safety endpoints were defined as vascular complications, severe bleeding (BARC</span><u><span style="font-family:Symbol">&gt;</span></u></span></span><span style="font-family:Calibri,sans-serif; font-size:10pt"><span style="font-family:Helvetica"><span style="color:#404040">3), hemolysis, and device-related embolic events. A comparison was conducted between in-hospital mortality, device-associated complications, and their relationship with the device weaning time. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:Helvetica"><span style="color:#404040">Results: </span></span></span></strong><span style="font-size:10.0pt"><span style="font-family:Helvetica"><span style="color:#404040">A total of<strong> </strong>23 pts were included: mean age 70&plusmn;12years; 65.2% males. There were no significant differences regarding CV risk factors between groups. All, except one pt in CS group, had multivessel coronary disease. There were 12 elective pts (52.2%) and 11pts with CS (47.8%). The latter group had higher in-hospital mortality (54.5% vs 0.0%, p=0.004). Among the CS group, mortality was higher in the subgroup with CS on admission (n=5, 71.4%) compared to intraprocedural CS subgroup (n=2, 50.0%). There were no intraprocedural deaths. Almost all electively admitted pts had the device removed immediately, while 72.7% of pts in the CS group had delayed device removal, with a median weaning time of 18h (24h for CS on admission pts vs 4h in intraprocedural CS pts). In CS, this time did not influence in-hospital mortality (p=0.513). A total of 8pts had device-related complications (4 bleeding, 2 vascular complications, 1 hemolysis, and 1 multiple embolization), primarily in the delayed-weaning group (7.1% vs 87.5%, p&lt;0.001). </span></span></span></span></span></p>

<p style="text-align:justify"><strong><span style="font-size:10.0pt"><span style="font-family:Helvetica"><span style="color:#404040">Conclusions: </span></span></span></strong><span style="font-size:10.0pt"><span style="font-family:Helvetica"><span style="color:#404040">Impella has shown to be safe and effective for elective pts. In CS, although it may assist in stabilizing pts during the procedure, its use was associated with an in-hospital mortality rate similar to that previously described. Its effectiveness did not rely on longer support, and this poses a higher risk of vascular complications. Although in this population CS caried a poor prognosis that was irrespective of device insertion, this suggests that complementary knowledge is needed for pt&nbsp;selection, in order to improve survival rates. </span></span></span></p>