P2481Impella assist device or intraaortic balloon pump for treatment of cardiogenic shock due to acute coronary syndrome

Abstract

Background/Introduction: Cardiogenic shock (CS) due to acute coronary syndrome (ACS) is associated with high mortality. Newer percutaneous assist devices such as the Impella® centrifugal pump may provide superior hemodynamic support compared to the former standard IABP. To date, however, only limited data are available that compare Impella® with IABP. Purpose: The aim of the present study was to compare the hemodynamic impact of Impella® versus IABP in patients with CS due to ACS and assess clinical benefits in terms of all‐cause mortality at 30 days. Methods: 116 consecutive patients with CS due to ACS treated with either Impella® or IABP and presenting between 2011 and 2017 to two tertiary care centers were included. Primary outcome was all‐cause mortality at 30 days. Secondary outcomes were surrogate parameters of shock severity (i.e., cardiac power index [CPI], inotropic score, serum lactate, SAPS II and left ventricular ejection fraction [LVEF]). Kaplan Meier analysis was used to estimate mortality at 30‐days in each device group and multivariate regression analysis to identify predictors of all‐cause mortality in the IABP‐SHOCK II Score subgroups. A generalized linear model assessed the improvement of the parameter of shock severity from baseline to the 4th day after device implantation and LVEF until discharge, considering between and within differences among the device groups. Results: 54 underwent circulatory support with IABP and 62 with Impella. Severity of disease at baseline, as assessed by the IABP‐SHOCK II Score, was similar between the groups. Although the improvement of the CPI did not differ among the two treatment groups (p=0.10), significant lower inotropic scores (p<0.001), reduced lactate levels (p<0.001) and SAPS II (p=0.02) were achieved with device therapy in the Impella as compared to the IABP group (Figure A‐C). Further, a significant increase in LVEF from baseline to hospital discharge was observed in these patients (p=0.01). At 30 days, all‐cause mortality was 52% (n=32) the Impella group and 67% (n=36) in the IABP group. At Kaplan Meier analysis all‐cause mortality was not significantly different between the two treatment groups (p=0.17, Figure D). After stratifying according to the IABP‐SHOCK II risk categories, multivariate analysis of 30‐day all‐cause mortality in the low‐intermediate risk group, showed a trend to lower mortality rates in Impella‐treated patients (HR 0.59, 95% CI 0.34 to 1.04, p=0.07) as compared to those treated with IAPB. (Figure Presented) Conclusions: In patients with CS due to ACS treatment with Impella improves significantly parameters of shock severity but is not superior to IABP in reducing all‐cause mortality at 30 days. The subgroup of patients with baseline lowintermediate mortality risk might benefit from treatment with Impella. Large‐scale, randomized studies are needed to investigate whether the favorable hemodynamic effects translate into mortality benefits.