title: The use of Impella 2.5 in severe refractory cardiogenic shock complicating an acute myocardial infarction.
abstract: OBJECTIVE
  To investigate the outcome of patients with acute myocardial infarction (AMI) complicated by refractory cardiogenic shock (CS) who underwent mechanical circulatory support with Impella 2.5.
  
  
  BACKGROUND
  AMI complicated by CS remains a highly fatal condition. A potent and minimally invasive left ventricular assist device might improve patient outcomes.
  
  
  METHODS
  We analyzed the procedural characteristics and outcomes of 22 consecutive patients who underwent, between July 2008 and December 2012, a percutaneous coronary intervention and Impella 2.5 support for AMI complicated by CS refractory to first-line therapy with inotropes and/or Intra-aortic balloon pump.
  
  
  RESULTS
  In this analysis, patients were relatively young with a mean age of 57.9 ± 11.6 year old and 59.1% were male. The majority of patients (77.3%) were admitted in CS and 40.9% sustained cardiac arrest prior to admission. Hemodynamics improved significantly upon initiation of support, end-organ and tissue perfusion improved subsequently demonstrated by a significant decrease in lactate levels from 6.37 ± 5.3 mmol/L to 2.41 ± 2.1 mmo/L, (P =  0.008) after 2 days of support. Thirteen (59.1%) patients were successfully weaned-off Impella 2.5 and 4 (18.2%) were transitioned to another device. We observed a functional recovery of the left ventricle when compared to baseline (43 ± 10% vs. 27 ± 9%, P < 0.0001). The survival rate at 6 months and 1 year was 59.1% and 54.5%, respectively.
  
  
  CONCLUSIONS
  Impella 2.5 was initiated as a last resort therapy to support very sick patients with refractory CS after failed conventional therapy. The use of the device yielded favorable short and mid-term survival results with recovery being the most frequently observed outcome.
authors.affiliation: Department of Interventional Cardiology and Intensive Care, Haut-Leveque Hospital, Pessac, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Casassus
authors.forename: Jerome
authors.initials: J
authors.lastname: Corre
authors.forename: Lionel
authors.initials: L
authors.lastname: Leroux
authors.forename: Pierre
authors.initials: P
authors.lastname: Chevalereau
authors.forename: Aurelie
authors.initials: A
authors.lastname: Fresselinat
authors.forename: Benjamin
authors.initials: B
authors.lastname: Seguy
authors.forename: Joachim
authors.initials: J
authors.lastname: Calderon
authors.forename: Pierre
authors.initials: P
authors.lastname: Coste
authors.forename: Alexandre
authors.initials: A
authors.lastname: Ouattara
authors.forename: Xavier
authors.initials: X
authors.lastname: Roques
authors.forename: Laurent
authors.initials: L
authors.lastname: Barandon
mesh_terms: D001775:Blood Circulation; D002316:Cardiotonic Agents / Q000009:adverse effects; D005260:Female; D005602:France / Q000453:epidemiology; D006353:Heart-Assist Devices; D006439:Hemodynamics; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D012770:Shock, Cardiogenic / Q000150:complications* / Q000401:mortality*; D017211:Treatment Failure
chemical_list: D002316:Cardiotonic Agents; D019344:Lactic Acid