Abstract 14959: Impact of Timing of Venoarterial Extracorporeal Membrane Oxygenation Insertion (Before or After Impella) in Patients With Acute Myocardial Infarction With Cardiogenic Shock Using Impella: From J-PVAD Registry

Abstract

Introduction: In patients with cardiogenic shock (CS), Impella, one type of percutaneous ventricular assist device with a catheter-type micro-axial heart pump, plus venoarterial extracorporeal membrane oxygenation (ECPELLA) has been reported to have a better short-term prognosis than venoarterial extracorporeal membrane oxygenation (VA-ECMO) alone, although it was associated with more complications. ECPELLA has often been used in current clinical practice instead of VA-ECMO alone. However, in many cases of acute myocardial infarction (AMI) with CS, there is controversy about whether Impella or VA-ECMO should be installed first. Hypothesis: What are the factors associated with Impella use first? Does the timing of VA-ECMO insertion affect prognosis and major adverse events (MAEs) such as hemolysis, hemorrhage/hematoma, peripheral ischemia, stroke, and thrombosis? This study aims to clarify the factors of Impella use first and the prognostic impact of the timing of VA-ECMO insertion (before or after Impella). Methods: The Japanese registry for Percutaneous Ventricular Assist Device (J-PVAD) has registered all consecutive Japanese patients treated with Impella between February 2020 and December 2021. In the current study, we evaluated 523 patients with AMI with CS and investigated the factors of Impella use before VA-ECMO and the impact of the timing of VA-ECMO insertion on 30 days mortality and MAEs. Results: Out of the total number of patients, 155 (30%) received Impella prior to VA-ECMO, while 367 (70%) received Impella following VA-ECMO. The factors of Impella use before VA-ECMO were the absence of out-of-hospital and in-hospital cardiac arrest. The cumulative 30-day incidence of all-cause death was 46.1% in patients with Impella use before VA-ECMO and 53.5% in those with Impella use after VA-ECMO (Log-rank P=0.13). There was no excess risk of Impella use before VA-ECMO relative to Impella use after VA-ECMO (adjusted HR, 0.95; 95%CI, 0.47-1.94; P=0.90). There were no significant differences in the incidence of MAEs between the two groups. Conclusions: The prognosis for patients with AMI complicated by CS requiring ECPELLA remained poor, but the timing of VA-ECMO insertion did not affect the prognosis.