Abstract 10170: Comparison of Impella, Intra-Aortic Balloon Pump, and Vasopressors Alone in Patients With Acute Myocardial Infarction and Cardiogenic Shock Undergoing Percutaneous Coronary Intervention

Abstract

Introduction: Previous studies have compared Impella to intra-aortic balloon pump (IABP) in patients with acute myocardial infarction and cardiogenic shock (AMI-CS) undergoing percutaneous coronary intervention (PCI) but did not include a cohort of patients receiving vasopressors alone. We assessed the hypothesis that there would be a difference in clinical outcomes in patients with AMI-CS undergoing PCI who received Impella alone, IABP alone, and vasopressor therapy without MCS. Methods: We queried the National Inpatient Sample inclusive of 2015 to 2018 and created three propensity-matched cohorts (Impella alone vs IABP alone, Impella alone vs vasopressors without MCS, and IABP alone vs vasopressors without MCS). We performed propensity matching by adjusting for 21 clinical variables including age, comorbidities, and presence of lactic acidosis. Patients receiving both MCS and vasopressors were excluded, in order to best isolate the effect of each intervention. Results: Among 17,762 hospitalized patients with AMI-CS undergoing PCI, Impella use was associated with significantly higher in-hospital mortality (40.6% vs 27.4%; p=0.003), major bleeding (29.3% vs 13.5%; p < 0.001), acute kidney injury (56.4% vs 45.9%; p=0.04), and hospital charges compared to IABP use (p <0.001) (Figure). Impella patients had significantly higher rates of mortality (42.8% vs 35.5%; p=0.01) and major bleeding (32.7% vs 22.5%; p=0.001), when compared to patients with vasopressors without MCS. There were no significant differences in clinical outcomes between IABP patients and patients receiving vasopressors without MCS. Conclusions: When compared to IABP or vasopressor therapy without MCS, Impella patients with AMI-CS undergoing PCI had higher mortality, major bleeding, and in-hospital costs. A vasopressor-only strategy showed no difference in clinical outcomes when compared to IABP. Randomized trials are necessary to determine optimal MCS management in AMI-CS.