• Dagmar M Ouweneel, Justin de Brabander, Mina Karami, Krischan D Sjauw, Annemarie E Engström, M Marije Vis, Joanna J Wykrzykowska, Marcel A Beijk, Karel T Koch, Jan Baan, Robbert J de Winter, Jan J Piek, Wim K Lagrand, Thomas Gv Cherpanath, Antoine Hg Driessen, Riccardo Cocchieri, Bas Ajm de Mol, Jan Gp Tijssen, and José Ps Henriques.
• 1 Heart Center; department of Cardiology, Amsterdam UMC, The Netherlands.
• Eur Heart J Acute Cardiovasc Care. 2019 Jun 1; 8 (4): 338-349.

AimsMortality in cardiogenic shock patients remains high. Short-term mechanical circulatory support with Impella can be used to support the circulation in these patients, but data from randomised controlled studies and 'real-world' data are sparse. The aim is to describe real-life data on outcomes and complications of our 12 years of clinical experience with Impella in patients with cardiogenic shock after acute myocardial infarction and to identify predictors of 6-month mortality.MethodsWe describe a single-centre registry from October 2004 to December 2016 including all patients treated with Impella for cardiogenic shock after acute myocardial infarction. We report outcomes and complications and identify predictors of 6-month mortality.ResultsOur overall clinical experience consists of 250 patients treated with Impella 2.5, Impella CP or Impella 5.0. A total of 172 patients received Impella therapy for cardiogenic shock, of which 112 patients had cardiogenic shock after acute myocardial infarction. The mean age was 60.1±10.6 years, mean arterial pressure was 67 (56-77) mmHg, lactate was 6.2 (3.6-9.7) mmol/L, 87.5% were mechanically ventilated and 59.6% had a cardiac arrest before Impella placement. Overall 30-day mortality was 56.2% and 6-month mortality was 60.7%. Complications consisted of device-related vascular complications (17.0%), non-device-related bleeding (12.5%), haemolysis (7.1%) and stroke (3.6%). In a multivariate analysis, pH before Impella placement is a predictor of 6-month mortality.ConclusionsOur registry shows that Impella treatment in cardiogenic shock after acute myocardial infarction is feasible, although mortality rates remain high and complications occur.

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