title: Use of the Impella Device for Acute Coronary Syndrome Complicated by Cardiogenic Shock - Experience From a Single Heart Center With Analysis of Long-term Mortality.
abstract: OBJECTIVE
  Impella is a microaxial rotary pump that is placed across the aortic valve to expel aspirated blood from the left ventricle into the ascending aorta; it can be used in cardiogenic shock. While previous studies have evaluated the efficacy and safety of the Impella device, more clinically relevant data are necessary, especially with regard to outcomes.
  
  
  RESULTS
  We screened our database of Impella patients in our heart center and found 68 consecutive patients who underwent Impella implantation due to acute coronary syndrome (ACS) complicated by cardiogenic shock. Data were evaluated with regard to baseline and procedural characteristics and also included an assessment of the short-term and long-term outcomes. The majority of patients (74%) suffered from an ST-elevation myocardial infarction, and 59% of patients received the Impella device during the initial coronary angiography. In the remaining cases, Impella implantation was performed at a later time, most commonly after IABP implantation. Patient characteristics were not significantly different between both groups. The predominantly implanted device was an Impella 2.5. Mortality in the severely ill patient population remained high, but univariate/multivariate analyses identified significant risk factors. Interestingly, delayed initiation of Impella support was an independent predictor of higher long-term mortality (hazard ratio, 2.157; P=.04) within the Impella patient cohort.
  
  
  CONCLUSIONS
  This large series of patients with ACS complicated by cardiogenic shock who underwent Impella implantation provides information on the relevant risk factors for mortality. Early (compared with delayed) initiation of Impella support was a predictor of improved survival in this population of patients.
authors.affiliation: University of Goettingen, Heart Center, Department of Cardiology and Pneumology, Robert-Koch-Str. 40, D-37099 Goettingen, Germany. mschroeter@med.uni-goettingen.de.
authors.forename: Marco Robin
authors.initials: MR
authors.lastname: Schroeter
authors.forename: Herdis
authors.initials: H
authors.lastname: Köhler
authors.forename: Astrid
authors.initials: A
authors.lastname: Wachter
authors.forename: Annalen
authors.initials: A
authors.lastname: Bleckmann
authors.forename: Gerd
authors.initials: G
authors.lastname: Hasenfuß
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schillinger
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D000368:Aged; D017023:Coronary Angiography / Q000379:methods; D061345:Early Medical Intervention / Q000706:statistics & numerical data; D004867:Equipment Design; D005260:Female; D005858:Germany / Q000453:epidemiology; D006353:Heart-Assist Devices; D006439:Hemodynamics; D006801:Humans; D000069451:Long Term Adverse Effects / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D012307:Risk Factors; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D016019:Survival Analysis; D061665:Time-to-Treatment / Q000706:statistics & numerical data