CONGRESS ABSTRACT

Background: cardiogenic shock (CS) remains a major complication of acute myocardial infarction (AMI), contributing significantly to morbidity and mortality. Temporary mechanical circulatory support (t-MCS) has gained prominence in CS management, also serving as a bridge during high-risk percutaneous coronary interventions (PCI). While the DanGer Shock Trial demonstrated the superiority of Impella CP over standard-of-care in CS management, the role of Impella 5.0/5.5 in these complex framework remains underexplored, despite its capacity to provide superior hemodynamic support. This study aims to analyze the clinical outcomes of AMI-related CS patients managed with Impella 5.0/5.5. Methods: this single-center, retrospective study evaluated in-hospital outcomes of patients with AMI-related CS supported with Impella 5.0/5.5. Data were retrieved from electronic medical records and analyzed descriptively, with results presented as mean or percentage values. Results: from January 2022 to May 2024, 28 patients received Impella 5.0/5.5 support. The mean age was 72 ± 8.9 years, and 96% were male. On admission, 11 patients (39%) were classified as SCAI stage C, 11 (39%) as SCAI D, and 6 (21%) as SCAI E. The mean left ventricular ejection fraction (LVEF) was 32% ± 11.7, with 50% presenting severe mitral regurgitation. ECMO was initiated in 11 (39%) patients due to further clinical deterioration, followed by Impella implantation. Escalation to intra-aortic balloon pump (IABP) occurred in 19 patients (67%). PCI was performed in 26 patients, 12 (46%) of whom had multivessel disease requiring ongoing revascularization. The mean duration of Impella support was 7.5 ± 10.5 days, ranging up to 50 days. Bleeding complications were rare, occurring in only 2 patients (7%). The overall in-hospital survival rate was 78%. Among survivors, 3 patients (14%) were bridged to durable LVAD, and 2 (9%) underwent heart transplantation (HTX). Both transplant recipients had severe CS with RV dysfunction requiring ECMO. At discharge, 17 patients (77%) achieved a median LVEF of 33%. Conclusions: Impella 5.0/5.5 played a crucial role in survival and myocardial recovery among AMI-related CS patients, demonstrating a low complication rate and effective left ventricular unloading. The modest bridge-to-transplant rate highlights the need for myocardial support in critically ill patients. Further prospective studies are warranted to confirm these findings and refine management strategies.