Does management at specialized LVAD center improve survival in AMI-related cardiogenic shock treated with ECPELLA?
M Nakamura, T Imamura, K KinugawaAbstract
Background
The prognosis of patients with acute myocardial infarction-related cardiogenic shock (AMI-CS) treated with veno-arterial extracorporeal life support (VA-ECLS) combined with Impella (i.e., ECPELLA) remains poor. Whether management at LVAD center confers a prognostic advantage compared with non-LVAD center remains uncertain.
Purpose
This study aimed to compare 30-day mortality between LVAD center and non-LVAD center among patients with AMI-CS receiving ECPELLA support, using data from the prospectively collected nationwide J-PVAD registry.
Methods
Among 4,910 patients who underwent Impella placement for AMI-CS between 2020 and 2023, those receiving ECPELLA were included in the final analysis. Exchange of Impella to the 5.0/5.5 device was defined as device upgrade. Cumulative mortality and adverse events were retrospectively compared between LVAD center and non-LVAD center.
Results
A total of 1,549 patients (median age 69 years; LVAD center 21.1%) were analyzed. The 30-day mortality was significantly lower at LVAD center than at non-LVAD center (45.5% versus 54.5%, p = 0.002; Figure). Management at LVAD center and Impella upgrade were independently associated with lower 30-day mortality, with adjusted hazard ratio of 0.791 (95% CI 0.658-0.953, p = 0.013) and 0.483 (95% CI 0.339-0.690, p < 0.001), respectively, instead of LVAD implantation.
Conclusions
Impella upgrade and management at LVAD center were associated with reduced 30-day mortality in patients with AMI-CS receiving ECPELLA. Further approaches are warranted to establish a standardized and regionalized network of care for cardiogenic shock.