Door to Impella Placement in Acute Coronary Syndrome Complicated by Cardiogenic Shock: An Updated Meta-Analysis
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.
Iannaccone M, Franchin L, Hanson I, Boccuzzi G, Basir MB, Truesdell AG, et al. Door to Impella placement in acute coronary syndrome complicated by cardiogenic shock: an updated meta-analysis. J Soc Cardiovasc Angiogr Interv. 2022 May-Jun;1(3 Suppl):100115. doi:10.1016/j.jscai.2022.100115.