Outcomes with Impella CP in acute myocardial infarction vs heart failure cardiogenic shock: Insights from the Cardiogenic Shock Working Group.
Publication Title
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
Document Type
Article
Publication Date
8-20-2025
Keywords
Impella; cardiogenic shock; heart failure; mechanical circulatory support; myocardial infarction.; oregon; portland; cards; cards publication
Abstract
BACKGROUND: Impella CP (Abiomed, Danvers, MA) microaxial flow pumps are commonly used in acute myocardial infarction (AMI) and heart failure (HF) cardiogenic shock (CS). Contemporary data from large, unselected populations are needed to understand differences between these groups.
METHODS: The Cardiogenic Shock Working Group registry enrolls patients with CS at 36 international sites. We analyzed patients with Impella CP enrolled from 2019-2024, categorized by CS etiology and mechanical support device exposure. Baseline characteristics, complications, and outcomes were compared. Outcomes included survival to discharge, native heart survival, and heart replacement therapy. Multivariable analysis was performed to identify predictors of in-hospital mortality and complications.
RESULTS: A total of 1,486 patients with CS (57.9% AMI-CS, 34.9% HF-CS) and Impella CP were analyzed. Patients with HF-CS were younger (60 vs 64 years; p < 0.001) and more likely to have chronic kidney disease (26.4% vs 13.6; p < 0.001) than those with AMI-CS. Impella CP alone was used in 38.3%, CP+ extracorporeal membrane oxygenation in 23.1%, and CP + ≥2 other devices in 20.4%. Acute kidney injury was more common in HF-CS than AMI-CS (66.5% vs 59.7%, p = 0.03) and acute limb ischemia more common in AMI-CS than HF-CS (14.4% vs 11.0%; p = 0.05). Survival to discharge was 53.4% and was higher in HF-CS than AMI-CS (59.7% vs 49.8%; p < 0.001). Those with ≥2 other devices had the lowest survival (43.8%). Total device number was significantly associated with in-hospital mortality, limb ischemia, and bleeding.
CONCLUSIONS: Differences in baseline characteristics, device exposure, and hospital complications between patients with HF-CS and AMI-CS supported by Impella CP may influence outcomes.
Area of Special Interest
Cardiovascular (Heart)
Specialty/Research Institute
Cardiology
DOI
10.1016/j.healun.2025.08.010
