Outcomes Among Patients Transferred for Revascularization With Impella for Acute Myocardial Infarction With Cardiogenic Shock from the cVAD Registry

Brian P. O'Neill, Mauricio G Cohen, Mir Babar Basir, Theodore Schreiber, Navin K. Kapur, Simon Dixon, Akshay K. Khandelwal, Cindy Grines, Erik Magnus Ohman, William W. O'Neill

Research output: Contribution to journalArticle

Abstract

The outcomes for patients transferred with cardiogenic shock and later treated with revascularization and Impella support have not previously been studied. To evaluate these outcomes, patients in cardiogenic shock were recruited from the catheter-based ventricular assist device registry, a prospective registry enrolling patients who underwent percutaneous coronary intervention with hemodynamic support using Impella 2.5 or CP. Analysis was performed on subgroups of patients who were characterized as those directly admitted to a tertiary care hospital (direct), or those transferred from an outside hospital (transfer). Patients who were transferred with acute myocardial infarction with cardiogenic shock (AMICS) more often presented in shock were in shock longer than 24 hours, and were more likely to be on intra-aortic balloon pump but were less likely to sustain cardiac arrest. The number of pressors, EF, diseased, and treated vessels were similar between the 2 groups. Despite baseline differences, the mortality was similar in the transfer versus direct patients (47.0% vs 53.5% p = 0.19). In a multivariate model, the factors independently associated with 30-day mortality in AMICS treated with revascularization and Impella support were cardiopulmonary resuscitation (CPR) (p <0.01), age (p <0.01), and ST-segment elevation myocardial infarction (STEMI) (p = 0.02). Whether the patient was transferred or directly admittedly with AMICS was not an independent predictor of death. In conclusion, these findings suggest that considerations should be given to transfer patients with AMICS to allow them to be treated in a contemporary manner.

Original languageEnglish (US)
JournalAmerican Journal of Cardiology
DOIs
StatePublished - Jan 1 2019

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Cardiogenic Shock
Registries
Myocardial Infarction
Shock
Patient Transfer
Heart-Assist Devices
Mortality
Cardiopulmonary Resuscitation
Percutaneous Coronary Intervention
Tertiary Healthcare
Heart Arrest
Tertiary Care Centers
Catheters
Hemodynamics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Outcomes Among Patients Transferred for Revascularization With Impella for Acute Myocardial Infarction With Cardiogenic Shock from the cVAD Registry. / O'Neill, Brian P.; Cohen, Mauricio G; Basir, Mir Babar; Schreiber, Theodore; Kapur, Navin K.; Dixon, Simon; Khandelwal, Akshay K.; Grines, Cindy; Ohman, Erik Magnus; O'Neill, William W.

In: American Journal of Cardiology, 01.01.2019.

Research output: Contribution to journalArticle

O'Neill, Brian P. ; Cohen, Mauricio G ; Basir, Mir Babar ; Schreiber, Theodore ; Kapur, Navin K. ; Dixon, Simon ; Khandelwal, Akshay K. ; Grines, Cindy ; Ohman, Erik Magnus ; O'Neill, William W. / Outcomes Among Patients Transferred for Revascularization With Impella for Acute Myocardial Infarction With Cardiogenic Shock from the cVAD Registry. In: American Journal of Cardiology. 2019.
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abstract = "The outcomes for patients transferred with cardiogenic shock and later treated with revascularization and Impella support have not previously been studied. To evaluate these outcomes, patients in cardiogenic shock were recruited from the catheter-based ventricular assist device registry, a prospective registry enrolling patients who underwent percutaneous coronary intervention with hemodynamic support using Impella 2.5 or CP. Analysis was performed on subgroups of patients who were characterized as those directly admitted to a tertiary care hospital (direct), or those transferred from an outside hospital (transfer). Patients who were transferred with acute myocardial infarction with cardiogenic shock (AMICS) more often presented in shock were in shock longer than 24 hours, and were more likely to be on intra-aortic balloon pump but were less likely to sustain cardiac arrest. The number of pressors, EF, diseased, and treated vessels were similar between the 2 groups. Despite baseline differences, the mortality was similar in the transfer versus direct patients (47.0{\%} vs 53.5{\%} p = 0.19). In a multivariate model, the factors independently associated with 30-day mortality in AMICS treated with revascularization and Impella support were cardiopulmonary resuscitation (CPR) (p <0.01), age (p <0.01), and ST-segment elevation myocardial infarction (STEMI) (p = 0.02). Whether the patient was transferred or directly admittedly with AMICS was not an independent predictor of death. In conclusion, these findings suggest that considerations should be given to transfer patients with AMICS to allow them to be treated in a contemporary manner.",
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