Korean Circ J.  2021 Jun;51(6):487-494. 10.4070/kcj.2021.0102.

Real-World Data on the Intravascular Microaxial Left Ventricular Flow Pump (Impella) in High-Risk Patients

• Rao SV

• KMID: 2516209
• DOI: http://doi.org/10.4070/kcj.2021.0102

Abstract

Mechanical circulatory support (MCS) devices maintain or improve hemodynamic profiles in patients at risk for hemodynamic deterioration during percutaneous coronary intervention (PCI) or those in cardiogenic shock. Clinical trials of MCS have been difficult to complete due to challenges with equipoise; however, there are several “real-world” comparative effectiveness analyses of outcomes of patients undergoing high-risk PCI or cardiogenic shock with different MCS. This review summarizes the real-world data on Impella and intra-aortic balloon pump, 2 of the most commonly used MCS, and provides insight into the limitations of such data and challenges to completing clinical trials.

Keyword

Mechanical circulatory support; Cardiogenic shock

Figure

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  Figure 1 Association between Impella and clinical outcomes compared with intra-aortic balloon pump among patients undergoing percutaneous coronary intervention (reprinted from Amin et al.10)).AKI = acute kidney injury; CI = confidence interval; OR = odds ratio.

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  Figure 2 In-hospital outcomes among propensity matched patients with acute myocardial infarction and cardiogenic shock undergoing percutaneous coronary intervention with either Impella or intra-aortic balloon pump (reprinted from Dhruva et al.11)).CI = confidence interval.

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  Figure 3 Recommended treatment algorithm for patients with cardiogenic shock from the American Heart Association scientific statement on the invasive management of acute myocardial infarction complicated by cardiogenic shock (reprinted from Henry et al.13)).BP = blood pressure; ICU = intensive care unit; LHC = left heart catheterization; MCS = mechanical circulatory support; RHC = right heart catheterization.

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