Outcomes of Impella compared with intra-aortic balloon pump in ST-elevation myocardial infarction complicated by cardiogenic shock.

Autor:	Thakkar S; Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA., Patel HP; Department of Internal Medicine, Louis A Weiss Memorial Hospital, Chicago, IL, USA., Kumar A; Section of Cardiovascular Research, Heart, Vascular and Thoracic Department, Cleveland Clinic Akron General, Akron, OH, USA.; Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA., Tan BE; Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA., Arora S; Department of Cardiology, Case Western University, Cleveland, OH, USA., Patel S; Department of Internal Medicine, Vassar Brothers Medical Center, Poughkeepsie, NY, USA., Doshi R; Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV, USA., Depta JP; Sands Constellation Heart Institute, Rochester Regional Health, Rochester, NY, USA., Kalra A; Section of Cardiovascular Research, Heart, Vascular and Thoracic Department, Cleveland Clinic Akron General, Akron, OH, USA.; Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA., Dani SS; Department of Cardiology, Lahey Hospital & Medical Center, MA, USA., Deshmukh A; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA., Badheka A; Heart and Vascular Center, The Everett Clinic, Everett, WA, USA., Widmer RJ; Department of Cardiovascular Medicine, Baylor Scott & White Health, Temple, TX, USA., Mamas MA; Keele Cardiovascular Research Group, Institute of Applied Clinical Science, Keele University, Stoke-on-Trent, UK.; Keele Cardiovascular Research Group, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK., Rihal CS; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA., Girotra S; Department of Cardiology, University of Iowa Carver College of Medicine, IA, USA., Panaich SS; Department of Cardiology, University of Iowa Carver College of Medicine, IA, USA.
Jazyk:	angličtina
Zdroj:	American heart journal plus : cardiology research and practice [Am Heart J Plus] 2021 Nov 19; Vol. 12, pp. 100067. Date of Electronic Publication: 2021 Nov 19 (Print Publication: 2021).
DOI:	10.1016/j.ahjo.2021.100067
Abstrakt:	Background: Despite limited randomized trial data demonstrating clinical efficacy, the utilization of Impella in ST-elevation myocardial infarction (STEMI) patients complicated with cardiogenic shock (CS) has increased over time. Methods: We identified 75,769 hospitalizations with STEMI complicated by CS between October 2015 and December 2018 using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. From this cohort, hospitalizations were stratified according to IABP or Impella placement. The primary outcome was all-cause in-hospital mortality. Secondary outcomes were divided into efficacy, safety, and device-related complications. Propensity-score matching was used to account for differences in the baseline characteristics between the groups. Logistic regression was performed to get the odds ratio and confidence intervals. Results: Among 75,769 admissions with STEMI and CS, hospitalizations with <18 years old, both IABP and Impella placement, and who underwent ECMO and/or LVAD implantation were excluded. After the exclusion, out of 72,791 admissions, 25,260 (34.70%) hospitalizations received IABP, and 7825 (10.75%) received Impella support. After propensity score-matched analysis, 7345 hospitalizations were included in each group. All-cause in-hospital mortality was higher in the hospitalizations requiring Impella support as compared to IABP (42.10% vs. 31.54%, adjusted OR 1.71; 95% confidence interval (CI) 1.60-1.84, P < 0.0001). Impella was associated with a higher risk of in-hospital complications and hospitalization cost compared with IABP. Conclusion: Impella compared with IABP in STEMI patients with CS was associated with higher in-hospital mortality and other adverse clinical and procedural outcomes. Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. (© 2021 The Authors.)
Databáze:	MEDLINE
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