Door to Impella Placement in Acute Coronary Syndrome Complicated by Cardiogenic Shock: An Updated Meta-Analysis

Document Type

Conference Proceeding

Publication Date


Publication Title

Journal of the Society for Cardiovascular Angiography & Interventions



The impact of time to hemodynamic support in acute myocardial infarction complicated by cardiogenic shock (AMICS) has yet to be defined. The aim of this meta-analysis was to evaluate the impact of timing of mechanical circulatory support (MCS) with Impella.


A systematic literature review and meta-analysis was conducted using PubMed and Cochrane databases. All studies reporting short-term mortality rates and timing of Impella insertion, pre vs during/post PCI, were included. Primary endpoint was short-term mortality (≤ 30 days), while secondary endpoints were midterm mortality, device-related bleeding and limb ischemia.


Of 1289 studies identified, 13 studies (6810 patients; 2970 patients identified as receiving Impella pre-PCI and 3840 patients receiving Impella during/post-PCI) were included in this analysis. Median age was 63.8 years (IQR, 63-65.7); 76% of patients were male, and a high prevalence of cardiovascular risk factors was noted across the entire population. Short-term mortality was significantly reduced in those receiving pre-PCI Impella support, 37.2% vs 53.6% (RR 0.7; CI 0.56-0.88). Midterm mortality was also lower in the pre-PCI group, 47.9% vs 73% (RR 0.81; CI 0.68-0.97). The rates of device-related bleeding (RR 1.05; CI 0.47-2.33) and limb ischemia (RR 1.6; CI 0.63-2.15) were similar between the two groups.


This analysis suggests that MCS placement with Impella prior to PCI in AMICS may have a positive impact on short- and midterm mortality compared with post-PCI placement, with similar outcome in terms of safety.




3 Suppl

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SCAI 2022 Scientific Sessions, May 19-22, 2022, Atlanta, GA.

34th Annual Symposium Transcatheter Cardiovascular Therapeutics, September 16-19, 2022, Boston, MA. Iannaccone M, Franchin L, Hanson I, Boccuzzi G, Basir M, Truesdell A, et al. Door to Impella placement in acute coronary syndrome complicated by cardiogenic shock: an updated meta-analysis. J Am Coll Cardiol. 2022 Sep 20;80(12 Suppl):B27. doi: 10.1016/j.jacc.2022.08.079.