1 Heart Center; department of Cardiology, Amsterdam UMC, The Netherlands.
2 Department of Intensive Care Medicine, Amsterdam UMC, The Netherlands.
Eur Heart J Acute Cardiovasc Care. 2019 Jun;8(4):338-349. doi: 10.1177/2048872618805486. Epub 2018 Nov 7.
Mortality 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.
We 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.
Our 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.
Our registry shows that Impella treatment in cardiogenic shock after acute myocardial infarction is feasible, although mortality rates remain high and complications occur.
心源性休克患者的死亡率仍然很高。短期机械循环支持使用 Impella 可以为这些患者循环提供支持，但随机对照研究和“真实世界”数据的数据仍然很少。目的是描述我们 12 年使用 Impella 治疗急性心肌梗死后心源性休克患者的临床经验的真实数据，并确定 6 个月死亡率的预测因素。
我们描述了 2004 年 10 月至 2016 年 12 月期间的一项单中心登记研究，该研究纳入了所有使用 Impella 治疗急性心肌梗死后心源性休克的患者。我们报告了结果和并发症，并确定了 6 个月死亡率的预测因素。
我们的整体临床经验包括 250 例使用 Impella 2.5、Impella CP 或 Impella 5.0 治疗的患者。共有 172 例患者接受了 Impella 治疗心源性休克，其中 112 例患者为急性心肌梗死后的心源性休克。患者平均年龄为 60.1±10.6 岁，平均动脉压为 67（56-77）mmHg，乳酸为 6.2（3.6-9.7）mmol/L，87.5%患者接受机械通气，59.6%患者在 Impella 植入前发生心脏骤停。总体 30 天死亡率为 56.2%，6 个月死亡率为 60.7%。并发症包括器械相关血管并发症（17.0%）、非器械相关出血（12.5%）、溶血（7.1%）和中风（3.6%）。多变量分析显示，Impella 植入前 pH 值是 6 个月死亡率的预测因素。
我们的登记研究表明，急性心肌梗死后心源性休克患者使用 Impella 治疗是可行的，尽管死亡率仍然很高，且会发生并发症。
