Aims: We investigated the clinical profiles, outcome and prognostic factors of patients under Impella support for pPCI and CS in our monocentric registry.
Results: We evaluated n=25 consecutive patients (males: 72%; age: 67.4+11.2 years; range: 43-86 years), treated with Impella devices from 11/2016 to 01/2018 at our tertiary center. Impella 3.5 / CP was used in 48%, and Impella 2.5 in 52% of the patients. 88% of the patients had ischemic heart disease, and additional 3 cases had CS due to non-ischemic cardiomyopathy (dilated cardiomyopathy: n=2; non-compaction cardiomyopathy: n=1). The indications for the implantation of Impella were pPCI in 48%, and CS in 52% of the patients, respectively. All cases with pPCI were treated with an Impella 2.5, while all but one CS cases were treated with an Impella 3.5 / CP (p<0.0001). The mean duration on Impella-support was 53.8+157 hours. The rate of non-fatal complications was 9.8% (i.e. bleeding, hematoma), however, no fatal complications due to the use of the Impella occurred. Intra-hospital mortality occurred in 52% of the total patients, and was significantly higher in CS patients (84.6%) as compared with patients with pPCI (16.7%; p=0.0007). Furthermore, intra-hospital mortality was significantly associated with CPR (p=0.0017), with peak creatine kinase (CK; p=0.0020), with peak high-sensitive Troponin T (hsTnT; p=0.0011), and with peak lactate (p=0.0002).
Conclusions: Our data confirm the safety of Impella for pPCI and CS. Intra-hospital mortality in severe CS patients is still high despite Impella support. In contrast, mortality in patients with severe coronary artery disease subjected to pPCI is low. In addition to myocardial ischemia markers (CK, hsTnT), peak lactate might prove a relevant prognostic marker for adverse outcome in this setting.