Abstract 18247: Society for Cardiovascular Angiography and Intervention Shock Staging is Associated With Outcomes in Patients With an Impella 5.5 Temporary Left Ventricular Assist Device
Jean-Luc A Maigrot, Randall C Starling, Edward G Soltesz, Nicholas G Smedira, Michael Tong, Shinya Unai, Pavan Bhat, David Moros, Eugene H Blackstone, Aaron J Weiss- Physiology (medical)
- Cardiology and Cardiovascular Medicine
Introduction: Surgically implanted microaxial ventricular assist devices (VAD) such as Impella 5.5 are increasingly used as temporary mechanical circulatory support (tMCS) in patients at risk for and with cardiogenic shock (CS). Understanding the associations between CS severity and outcomes in patients supported with Impella 5.5 may optimize patient selection and prevent futile interventions.
Hypothesis: Increasingly severe Society for Cardiovascular Angiography and Intervention (SCAI) SHOCK stages in patients supported with Impella 5.5 are associated with worse outcomes.
Methods: From 2019-2022, retrospective review of perioperative characteristics, SCAI SHOCK stage and outcomes in patients supported with an Impella 5.5.
Results: In total, 228 Impella 5.5s were implanted in 226 patients; 28% (63) SCAI SHOCK stage A, 4% (10) stage B, 14% (31) stage C, 46% (104) stage D and 9% (20) stage E. Stage A and B patients more often had elective Impella 5.5s for tMCS-assisted interventions (cardiac surgery, PCI, VT ablation) (30%, 69/228) while stage C-E patients primarily had Impella 5.5 placement for acute MI (AMI), chronic cardiomyopathy and postcardiotomy CS (60%, 136/228) (p<0.01). Death on Impella support by SCAI SHOCK stage was: A 3.2%, B 10%, C 13%, D 27%, E 37% (p<0.01). The transition to durable VAD or heart transplant by SCAI SHOCK stage was: A 1.6%, B 0%, C 48%, D 35%, E 16% (p<0.01).
Conclusions: Patients supported with Impella 5.5s presented in varying degrees of CS as defined by SCAI SHOCK stage. Patients with AMI, chronic cardiomyopathy, and postcardiotomy CS more commonly presented in higher SCAI SHOCK stages than those who underwent planned Impella 5.5-assisted cardiac interventions. Patients in stage E at implant had the highest mortality while patients in stage C and D were more likely to be bridged to durable VAD or heart transplant.