Impella use during high-risk PCI leads to better survival and outcomes compared to IABP

The outcomes were: myocardial infarction (MI), in-hospital survival, cardiogenic shock, bleeding requiring transfusion, stroke, index hospitalization length of stay, costs, and acute kidney injury. Forty-eight thousand one hundred seventy-nine patients were treated with Impella or IABP mechanical circulatory support from April 2016 to June 2019 in US hospitals. Out of these, the authors identified 2,156 patients undergoing nonemergent high-risk PCI treated with Impella (n = 1,447) or IABP (n = 709).

The study led to the following findings:

• After propensity adjustment, Impella use was associated with improved survival (odds ratio [OR] 1.55) and less MI (OR 0.29), and cardiogenic shock (OR 0.54).
• Stroke, bleeding requiring transfusion, and acute kidney injury was similar between groups.
• After adjustment, the mean hospital length of stay was 3.4 days with Impella and 4.8 days with IABP.
• Mean hospital costs were 37% higher with the PVAD ($48,784 vs. $35,655 with IABP).
• Among surviving patients, costs were 43% higher in the Impella group ($47,541 vs. $33,240 with IABP).
• Cardiogenic shock was the strongest predictor of in-hospital mortality (OR 7.54). Others included MI, stroke, and bleeding requiring transfusion.

The researchers conclude, "Impella use during nonemergent high-risk PCI was linked with improved survival and reduced in-hospital myocardial infarction and cardiogenic shock compared with an intra-aortic balloon pump."

Reference:

Lansky AJ, Tirziu D, Moses JW, Pietras C, Ohman EM, O'Neill WW, Ekono MM, Grines CL, Parise H. Impella Versus Intra-Aortic Balloon Pump for High-Risk PCI: A Propensity-Adjusted Large-Scale Claims Dataset Analysis. Am J Cardiol. 2022 Oct 6:S0002-9149(22)00950-X. doi: 10.1016/j.amjcard.2022.08.032. Epub ahead of print. PMID: 36210212.