AUTHOR=Schäfer Andreas , Westenfeld Ralf , Sieweke Jan-Thorben , Zietzer Andreas , Wiora Julian , Masiero Giulia , Sanchez Martinez Carolina , Tarantini Giuseppe , Werner Nikos 

TITLE=Complete Revascularisation in Impella-Supported Infarct-Related Cardiogenic Shock Patients Is Associated With Improved Mortality

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 8 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.678748

DOI=10.3389/fcvm.2021.678748

ISSN=2297-055X

ABSTRACT=Background: Acute myocardial infarction-related cardiogenic shock (AMI-CS) still has high likelihood of in-hospital mortality. The only trial evidence currently available for the intra-aortic balloon pump showed no benefit of its routine use in AMI-CS. While a potential benefit of complete revascularisation has been suggested in urgent revascularisation, the CULPRIT-SHOCK trial demonstrated no benefit of multivessel compared to culprit-lesion only revascularisation in AMI-CS. However, mechanical circulatory support was only used in a minority of patients. 
Objectives: We hypothesised that more complete revascularisation facilitated by Impella support is related to lower mortality in AMI-CS patients. 
Methods: We analysed data from 202 consecutive Impella-treated AMI-CS patients at four European high-volume shock centres (age 66±11 years, 83% male). 47% (n=94) had cardiac arrest before Impella implantation. Revascularisation was categorised as incomplete if residual SYNTAX-score (rS) was >8.
Results: Overall 30-day mortality was 47%. Mortality was higher when Impella was implanted post-PCI (Impella-post-PCI: 57%, Impella-pre-PCI: 38%, p=0.0053) and if revascularisation was incomplete (rS≤8: 37%, rS>8: 56%, p=0.0099). Patients with both pre-PCI Impella implantation and complete revascularisation had significantly lower mortality (33%) than those with incomplete revascularisation and implantation post PCI (72%, p<0.001).
Conclusions: Our retrospective analysis suggests that complete revascularisation supported by an Impella microaxial pump implanted is associated with lower mortality than incomplete revascularisation in patients with AMI-CS.