Short-Term Outcomes of Impella Support in Japanese Patients With Cardiogenic Shock Due to Acute Myocardial Infarction　― Japanese Registry for Percutaneous Ventricular Assist Device (J-PVAD) ―

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  • Ikeda Yuki
    Department of Cardiovascular Medicine, Kitasato University, School of Medicine
  • Ako Junya
    Department of Cardiovascular Medicine, Kitasato University, School of Medicine
  • Toda Koichi
    Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
  • Hirayama Atsushi
    Department of Cardiology, Osaka Police Hospital
  • Kinugawa Koichiro
    The Second Department of Internal Medicine, University of Toyama
  • Kobayashi Yoshio
    Department of Cardiovascular Medicine, Graduate School of Medicine, Chiba University
  • Ono Minoru
    Department of Cardiac Surgery, Graduate School of Medicine, University of Tokyo
  • Nishimura Takashi
    Department of Cardiovascular and Thoracic Surgery, Graduate School of Medicine, Ehime University
  • Sato Naoki
    Department of Cardiology, Kawaguchi Cardiovascular and Respiratory Hospital
  • Shindo Takahiro
    Division of Cardiology, National Center for Child Health and Development
  • Takayama Morimasa
    Department of Cardiovascular Internal Medicine, Sakakibara Heart Institute
  • Yasukochi Satoshi
    Department of Pediatric Cardiology, Nagano Children’s Hospital
  • Shiose Akira
    Department of Cardiovascular Surgery, Kyushu University Graduate School of Medicine
  • Sawa Yoshiki
    Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
  • J-PVAD Investigators

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Description

<p>Background: The Impella®percutaneous left ventricular assist device has been available in Japan since 2017. This is the first large-scale registry study to analyze the efficacy and safety of Impella in Japanese patients with acute myocardial infarction with cardiogenic shock (AMICS).</p><p>Methods and Results: The Japanese registry for Percutaneous Ventricular Assist Device (J-PVAD) has registered all consecutive Japanese patients treated with Impella. We extracted data for 593 AMICS patients from J-PVAD and analyzed 30-day survival and safety profiles. Overall 30-day survival was 63.1%. The 30-day survival of the Impella alone and Impella plus venoarterial extracorporeal membrane oxygenation (ECPELLA) groups was 80.9% and 45.7%, respectively. The Impella alone group was older and had a lower rate of cardiac arrest, milder consciousness disturbance, less inotrope use, lower serum lactate concentrations, higher B-type natriuretic peptide concentrations, and higher left ventricular ejection fraction (LVEF) than the ECPELLA group. Cox regression analysis revealed that older age and comorbid renal disturbance were common risk factors affecting 30-day mortality in both groups. Major adverse events were hemolysis (10.8%), hemorrhage/hematoma (7.6%), peripheral ischemia (4.4%), stroke (1.3%), and thrombosis (0.7%). LVEF improved in both groups during support.</p><p>Conclusions: AMICS treatment with Impella showed favorable 30-day survival and safety profiles. The survival rate of patients treated with Impella alone was particularly high. Further studies are needed to improve outcomes of patients with ECPELLA support.</p>

Journal

  • Circulation Journal

    Circulation Journal 87 (5), 588-597, 2023-04-25

    The Japanese Circulation Society

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