Intra-aortic balloon pump better than Impella: new observational data

New data demonstrates that the use of the Impella device is associated with worse outcomes in cardiogenic shock and high-risk percutaneous coronary intervention (PCI) patients when compared with an intra-aortic balloon pump (IABP).

Presented by Dr Sanket S. Dhruva (University of California, San Francisco, USA), this observational study identified 28,304 matched patients with acute myocardial infarction with cardiogenic shock (AMICS) undergoing PCI from the National Cardiovascular Data Registry (NCDR) for the period between October 2015 and December 2017 [1]. The mean age was 65 years, 33% were female, 81.3% had had a STEMI, and 43.3% had had cardiac arrest. Dr Dhruva noted that use of the Impella rose from 3.5% to 8.7% in AMICS patients during the study period.

Within this large cohort, researchers identified 1,680 propensity-matched pairs who received Impella versus IABP. Results showed that the use of the Impella device was associated with significantly higher rates of in-hospital mortality and major bleeding "regardless of timing of device placement" as compared with IABP. In-hospital mortality was 45.0% with Impella and 34.1% with IABP. Major bleeding affected 31.3% and 16.0% of the Impella and IABP patients, respectively.

Dr Dhruva concluded, “These data provide important insights into the performance of mechanical circulatory support devices in routine clinical practice, and outcomes in randomised controlled trial settings may differ. Better evidence and guidance are needed regarding the optimal management of patients with AMICS as well as the role of mechanical circulatory support devices in general, and Impella in particular.”

1. Dhruva SS, et al. Comparative effectiveness and costs of Impella versus intra-aortic balloon pump in the United States. LBS04, AHA Scientific Sessions 2019, 14-18 November, Philadelphia, USA.



Posted on 26 February 202031 March 2021