Cardiogenic shock etiology and exit strategy impact survival in patients with Impella 5.5

Background: Despite historical differences in cardiogenic shock (CS) outcomes by etiology, outcomes by CS etiology have yet to be described in patients supported by temporary mechanical circulatory support (MCS) with Impella 5.5. Objectives: This study aims to identify differences in survival and post-support destination for these patients in acute myocardial infarction (AMI) and acute decompensated heart failure (ADHF) CS at a high-volume, tertiary, transplant center. Methods: A retrospective review of patients who received Impella 5.5 at our center from November 2020 to June 2022 was conducted. Results: Sixty-seven patients underwent Impella 5.5 implantation for CS; 23 (34%) for AMI and 44 (66%) for ADHF. AMI patients presented with higher SCAI stage, pre-implant lactate, and rate of prior MCS devices, and fewer days from admission to implantation. Survival was lower for AMI patients at 30 days, 90 days, and discharge. No difference in time to all-cause mortality was found when excluding patients receiving transplant. There was no significant difference in complication rates between groups. Conclusions: ADHF-CS patients with Impella 5.5 support have a significantly higher rate of survival than patients with AMI-CS. ADHF patients were successfully bridged to heart transplant more often than AMI patients, contributing to increased survival.

Automated summary

This study found differences in survival and post-support destination between acute myocardial infarction (AMI) cardiogenic shock (CS) patients and acute decompensated heart failure (ADHF) CS patients receiving Impella 5.5 support. ADHF-CS patients had a higher survival rate and were more likely to be successfully bridged to heart transplantation.