Clinical InvestigationAnalysis of outcomes for 15,259 US patients with acute myocardial infarction cardiogenic shock (AMICS) supported with the Impella device
Section snippets
Methods
In 2009, the manufacturer of the Impella PVAD (Abiomed) initiated a quality improvement (IQ) registry to collect and collate clinical and technical data from patients in the US treated with an Impella (2.5, CP or 5.0) device. The manufacturer provided technical support to clinicians using a team of trained clinical specialists who were present at device implantation and followed the patient throughout their hospital course until device explantation. From January 2009 to December 2016, a total
Results
From January 2009 to December 2016, 15,259 patients with AMICS from 1010 US hospitals received Impella devices and were entered into the IQ registry. Of these, 479 patients were also entered into the cVAD registry and were available for analysis. Baseline characteristics for the 2 groups are shown in Table I. There were similarities between the 2 patient cohorts, but the variables in the IQ registry are limited. The type of Impella device used in each registry is also shown in Table I.
Discussion
The IQ registry collected limited data among patients with AMICS who received an Impella device at 1010 US hospitals between 2009 and 2016. Using data from this registry, we identified wide variation in outcomes when an Impella device was used. Our findings further suggest that high-volume hospitals have a better survival to device explantation as compared with low-volume hospitals. While this registry cannot fully explore the reason for this volume–outcome relationship, this is consistent with
Conclusion
This analysis of Impella PVAD use for the treatment of patients with AMICS at 1010 US hospitals between 2009–2016 represents the initial learning curve experience for US physicians and hospitals. Wide variation in survival exists between US hospitals. Practice patterns that consist of early initiation of MCS, before PCI, use of right heart monitoring, and greater institutional experience are associated with improved survival. These practices are being prospectively studied in the National
Acknowledgments
We are grateful for editorial assistance by Elizabeth Cook and Betty Summers.
Funding Source
The IQ database and cVAD registry are supported by Abiomed.
Disclosures
O'Neill: Consultant: MDT, Edwards Lifesciences, BSCI and Abiomed.
Grines: Speaker honorarium: Abiomed.
Schreiber: None.
Moses: None.
Maini: Speaker's bureau, Advisory board and contracted research: Abiomed, Siemens, Medtronic, Abbott Vascular, Boston Scientific.
Dixon: None.
Ohman: Consultant: Abiomed, Biotie, Boehringer Ingelheim, Chiesi, Faculty Connection, Gilead Sciences, and Medscape. Research grant: Gilead Sciences.
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