Abstract
Background:
Cardiogenic shock (CS) is still one of the leading causes of cardiovascular mortality despite advances in therapeutic options. Aggressive management with percutaneous coronary intervention (PCI) and the use of mechanical circulatory support (MCS) devices has been associated with improved survival. The most frequently used MCS devices are the intra-aortic balloon pump (IABP) and the axial flow pump (Impella).
Aim:
To assess in-hospital bleeding complications and outcomes in CS patients treated with either Impella alone vs. IABP combined with Impella while undergoing PCI.
Methods:
Between 12/2010 and 03/2018 a total of 62 CS patients underwent PCI with Impella (n = 33) or IABP and Impella combined (n =29) at 6 hospitals in our system. Bleeding complications were classified according to the Bleeding Academic Research Consortium (BARC). BARC Type 4 (coronary bypass grafting-related) and Type 5 (fatal) bleeding events were excluded. Chi square was used for categorical values and t-test for continuous variables. P<0.05 was considered significant.
Results:
Clinical characteristics, bleeding complications and in-hospital outcomes are shown in the Table. There was a trend towards a higher percentage of STEMI patients treated with both devices. There was a significant higher rate of BARC 2 bleeding events in patients treated with both devices (6% v 28%, p=0.02) and a higher rate of BARC 3 bleeding events in patients treated with Impella alone (70% v 38%, p=0.01). Both groups had high rates of acute kidney failure and acute neurological events.
Conclusions:
In a limited series of CS patients undergoing PCI: 1) the use of Impella alone was associated with a significantly higher rate of BARC 3 major bleeding events; 2) patients treated simultaneously with both devices had a significantly higher rate of BARC 2 bleeding events; and 3) in-hospital acute neurological events and mortality rates were very high but similar in both groups.