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

Impella received approval from the US Food and Drug Administration in 2015 for use during high-risk PCIs; however, its safety and efficacy compared with intra-aortic balloon pump remains debated and has not been evaluated in contemporary practice. Alexandra J. Lansky, Division of Cardiology, Yale School of Medicine, New Haven, Connecticut, and colleagues aimed to compare the real-world practice of the postapproval outcomes and costs of Impella versus IABP support for high-risk PCI across hospitals in the USA.

For this purpose, the researchers identified patients from the Premier Healthcare Database undergoing nonemergent Impella- or IABP-supported high-risk PCI. Propensity adjustment was used to control baseline, procedure, and post-PCI medical treatment differences between treatment groups.

Patients undergoing nonemergent single-PCI procedures with either Impella or IABP were included. Patients with acute ST-elevation myocardial infarction, cardiogenic shock, or needing >1 mechanical support device during the index hospitalization were excluded.

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.