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Impella Support for Acute Myocardial Infarction Complicated by Cardiogenic Shock: Matched-Pair IABP-SHOCK II Trial 30-Day Mortality Analysis

Open access
Schrage, Benedikt, Ibrahim, Karim, Loehn, Tobias, Werner, Nikos, Sinning, Jan-Malte, Pappalardo, Federico, Pieri, Marina, Skurk, Carsten, Lauten, Alexander, Landmesser, Ulf, Westenfeld, Ralf, Horn, Patrick, Pauschinger, Matthias, Eckner, Dennis, Twerenbold, Raphael, Nordbeck, Peter, Salinger, Tim, Abel, Peter, Empen, Klaus, Busch, Mathias C., Felix, Stephan B., Sieweke, Jan-Thorben, Møller, Jacob Eifer, Pareek, Nilesh, Hill, Jonathan, MacCarthy, Philip, Bergmann, Martin W., Henriques, José P.S., Möbius-Winkler, Sven, Schulze, P. Christian, Ouarrak, Taoufik, Zeymer, Uwe, Schneider, Steffen, Blankenberg, Stefan, Thiele, Holger, Schäfer, Andreas, Westermann, Dirk·2019·Circulation

Abstract

Background: Percutaneous mechanical circulatory support devices are increasingly used in acute myocardial infarction complicated by cardiogenic shock (AMI-CS), despite limited evidence for their effectiveness. The aim of this study was to evaluate outcomes associated with use of the Impella device compared with intra-aortic balloon pump (IABP) and medical treatment in patients with AMI-CS. Methods: Data of patients with AMI-CS treated with the Impella device at European tertiary care hospitals were collected retrospectively. All patients underwent early revascularization and received optimal medical treatment. Using IABP-SHOCK II (Intraaortic Balloon Pump in Cardiogenic Shock II) trial inclusion and exclusion criteria, 372 patients were identified and included in this analysis. These patients were matched to 600 patients from the IABP-SHOCK II trial. The following baseline criteria were used as matching parameters: age, sex, mechanical ventilation, ejection fraction, prior cardiopulmonary resuscitation, and lactate. Primary end point was 30-day all-cause mortality. Results: In total, 237 patients treated with an Impella could be matched to 237 patients from the IABP-SHOCK II trial. Baseline parameters were similarly distributed after matching. There was no significant difference in 30-day all-cause mortality (48.5% versus 46.4%, P =0.64). Severe or life-threatening bleeding (8.5% versus 3.0%, P <0.01) and peripheral vascular complications (9.8% versus 3.8%, P =0.01) occurred significantly more often in the Impella group. Limiting the analysis to IABP-treated patients as a control group did not change the results. Conclusions: In this retrospective analysis of patients with AMI-CS, the use of an Impella device was not associated with lower 30-day mortality compared with matched patients from the IABP-SHOCK II trial treated with an IABP or medical therapy. To further evaluate this, a large randomized trial is warranted to determine the effect of the Impella device on outcome in patients with AMI-CS. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03313687.

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Metadata

Authors
Schrage, B., Ibrahim, K., Loehn, T., Werner, N., Sinning, J.-M., Pappalardo, F., Pieri, M., Skurk, C., Lauten, A., Landmesser, U., Westenfeld, R., Horn, P., Pauschinger, M., Eckner, D., Twerenbold, R., Nordbeck, P., Salinger, T., Abel, P., Empen, K., Busch, M. C., Felix, S. B., Sieweke, J.-T., Møller, J. E., Pareek, N., Hill, J., MacCarthy, P., Bergmann, M. W., Henriques, J. P. S., Möbius-Winkler, S., Schulze, P. C., Ouarrak, T., Zeymer, U., Schneider, S., Blankenberg, S., Thiele, H., Schäfer, A., & Westermann, D.
Venue
Circulation
Published
2019-03-05
Volume
139
Issue
10
Pages
1249-1258
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
OpenAlex
W2902903841
Cited by
503
References
18
FWCI
24.71
Type
journal article
Language
en
Open access
bronze

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CoChat. (2026). Citation check: Impella Support for Acute Myocardial Infarction Complicated by Cardiogenic Shock: Matched-Pair IABP-SHOCK II Trial 30-Day Mortality Analysis. https://app.cochat.ai/papers/10.1161/circulationaha.118.036614
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Schrage, B., Ibrahim, K., Loehn, T., Werner, N., Sinning, J.-M., Pappalardo, F., Pieri, M., Skurk, C., Lauten, A., Landmesser, U., Westenfeld, R., Horn, P., Pauschinger, M., Eckner, D., Twerenbold, R., Nordbeck, P., Salinger, T., Abel, P., Empen, K., . . . Westermann, D. (2019). Impella Support for Acute Myocardial Infarction Complicated by Cardiogenic Shock: Matched-Pair IABP-SHOCK II Trial 30-Day Mortality Analysis. Circulation. https://doi.org/10.1161/circulationaha.118.036614

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Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).

Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.