Timing of Impella implantation and outcomes in cardiogenic shock or high-risk percutaneous coronary revascularization

被引：14

作者：

Tarantini, Giuseppe ^{[1
]}

Masiero, Giulia ^{[1
]}

Burzotta, Francesco ^{[2
]}

Pazzanese, Vittorio ^{[3
]}

Briguori, Carlo ^{[4
]}

Trani, Carlo ^{[2
]}

Piva, Tommaso ^{[5
]}

De Marco, Federico ^{[6
]}

Di Biasi, Maurizio ^{[7
]}

Pagnotta, Paolo ^{[8
]}

Mojoli, Marco ^{[9
]}

Casu, Gavino ^{[10
]}

Giustino, Gennaro ^{[11
]}

Lorenzoni, Giulia ^{[12
]}

Montorfano, Matteo ^{[13
]}

Ancona, Marco B. ^{[13
]}

Pappalardo, Federico ^{[3
]}

Chieffo, Alaide ^{[13
]}

机构：

[1] Univ Padua, Dept Cardiac Thorac Vasc Sci & Publ Hlth, Via Giustiniani 2, I-35128 Padua, Italy

[2] Univ Cattolica Sacro Cuore, Div Cardiol, Fdn Policlin Univ Gemelli IRCCS, Rome, Italy

[3] Univ Vita Salute San Raffaele, San Raffaele Sci Inst, Div Cardiol, Adv Heart Failure & Mech Circulatory Support Prog, Milan, Italy

[4] Mediterranea Cardioctr, Div Cardiol, Intervent Cardiol Unit, Naples, Italy

[5] Osped Riuniti Ancona, Div Cardiol, Intervent Cardiol Unit, Ancona, Italy

[6] IRCCS Policlin San Donato, Dept Clin & Intervent Cardiol, Milan, Italy

[7] Osped L Sacco, Div Cardiol, Intervent Cardiol Unit, Milan, Italy

[8] Humanitas Res Hosp, Div Cardiol, Cardiovasc Dept, Milan, Italy

[9] Osped Santa Maria Angeli, Div Cardiol, Pordenone, Italy

[10] Osped San Francesco, Intervent Cardiol Unit, Nuoro, Italy

[11] Icahn Sch Med Mt Sinai, Zena & Michael Wiener Cardiovasc Inst, New York, NY 10029 USA

[12] Univ Padua, Dept Cardiac, Unit Biostat Epidemiol & Publ Hlth, Padua, Italy

[13] IRCCS San Raffaele Sci Inst, Intervent Cardiol Unit, Div Cardiol, Milan, Italy

来源：

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS | 2021年 / 98卷 / 02期

关键词：

cardiogenic shock; high‐ risk PCI; left ventricular assist device; mechanical cardiac support;

D O I：

10.1002/ccd.29674

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objective To evaluate the role of the microaxial percutaneous mechanical circulatory support device (Impella (R) pump) implantation pre-percutaneous coronary intervention (PCI) versus during/after PCI in cardiogenic shock (CS) and high-risk PCI populations. Background A better understanding of the safety and effectiveness of the Impella and the role of timing of this support initiation in specific clinical settings is of utmost clinical relevance. Methods A total of 365 patients treated with Impella 2.5/CP in the 17 centers of the IMP-IT Registry were included. Through propensity-score weighting (PSW) analysis, 1-year clinical outcomes were assessed separately in CS and HR-PCI patients, stratified by timing of Impella support. Results Pre-procedural insertion was associated with an improvement in 1-year survival in patients with CS due to acute myocardial infarction (AMI) treated with PCI (p = .04 before PSW, p = .009 after PSW) and HR-PCI (p < .01 both before and after PSW). Among patients undergoing HR-PCI, early Impella support was also associated with a lower rate of the composite of mortality, re-hospitalization for heart failure, and need for left-ventricular assist device/heart transplantation at 1-year (p = .04 before PSW, p = .01 after PSW). Furthermore, Impella use during/after PCI was associated with an increased in-hospital life-threatening and severe bleeding among patients with AMI-CS receiving PCI (7 vs. 16%, p = .1) and HR-PCI (1 vs. 9%, p = .02). Conclusions Our findings suggested a survival benefit and reduced rates of major bleeding when a pre-PCI Impella implantation instead of during-after procedure was used in the setting of HR-PCI and AMI-CS.

引用

页码：E222 / E234

页数：13

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[21] THE CENTRAL ROLE OF THE PROPENSITY SCORE IN OBSERVATIONAL STUDIES FOR CAUSAL EFFECTS [J].