A-18 | In-Hospital Outcomes of Impella versus ECMO in ST Elevation Myocardial Infarction (STEMI) Complicated by Cardiogenic Shock
Khalid, Yaser Dasu, Kirti Roy, Trinava Umrani, Rohan Dasu, Neethi Gabriel, Nielsen
Khalid, Yaser
Dasu, Kirti
Roy, Trinava
Umrani, Rohan
Dasu, Neethi
Gabriel, Nielsen
Citations
Altmetric:
Genre
Journal article
Date
2023-05-18
Advisor
Committee member
Group
Department
Subject
Permanent link to this record
Collections
Research Projects
Organizational Units
Journal Issue
DOI
https://doi.org/10.1016/j.jscai.2023.100682
Abstract
Background: Short-term mechanical support such as an ECMO or Impella have been utilized as bridge therapy to treat ST-elevation myocardial infarction (STEMI) complicated by cardiogenic shock. Our aim of the study was to compare in-hospital outcomes associated with ECMO and Impella in patients with STEMI complicated by cardiogenic shock. Methods: In a retrospective study of National Inpatient Sample 2017 data, we used ICD-10 codes to identify patients with a primary diagnosis of STEMI and cardiogenic shock who received ECMO or Impella while hospitalized. Multivariate logistic regression was used to adjust for patient demographics, hospital demographics, and relevant comorbidities. Primary outcomes were mortality, length of stay (LOS), and total hospital charges (TOTHC). Results: Among 47,022 patients hospitalized for STEMI, 874 (1.8%) received Impella support and 210 (0.4%) received ECMO support. ECMO use was associated with greater in-hospital mortality (59% vs 43%, odds ratio [OR] 4.19, p<0.001), LOS (19 days vs. 9 days, OR 6.86, p<0.0001) and TOTHC ($780,00 vs $380,000, OR, p<0.0001) than Impella support. Furthermore, ECMO patients more frequently had respiratory failure (OR 1.99, p<0.046) and ventricular tachycardia or fibrillation (26.05% vs 20.74%, OR 1.35, p=0.008), and respiratory failure requiring intubation (42.21% vs 28.53%, OR 1.83, p<0.001) but patients with Impella support had higher acute kidney injury (42.3% vs 17.9%, OR 3.16, p<0.002) and cardiac arrest (64.3% vs 18.3%, OR 2.38, p<0.017). There was no statistically significant difference in acute gastrointestinal bleeding, CVA/TIA, ICH (p>0.1). Females also had higher mortality than males for both devices (OR 3, p<0.03). Conclusions: Previous clinical trials have associated comparable outcomes with Impella to ECMO in patients with STEMI and cardiogenic shock. Both devices are associated with a lower all-cause 30 day mortality and lower inotrope use as well as comparable safety outcomes. Our results suggest that in real-world inpatient STEMI complicated by cardiogenic shock, ECMO was associated with a higher hospital mortality, hospital length of stay, and total hospital charges compared to Impella support. Disclosures: Y. Khalid Nothing to disclose. K. Dasu Nothing to disclose. T. Roy Nothing to disclose. R. Umrani Nothing to disclose. M. Lee Nothing to disclose. N. Dasu Nothing to disclose. N. Gabriel Nothing to disclose.
Description
Citation
Yaser Khalid, Kirti Dasu, Trinava Roy, Rohan Umrani, Michael Lee, Neethi Dasu, Nielsen Gabriel, A-18 | In-Hospital Outcomes of Impella versus ECMO in ST Elevation Myocardial Infarction (STEMI) Complicated by Cardiogenic Shock, Journal of the Society for Cardiovascular Angiography & Interventions, Volume 2, Issue 3, Supplement, 2023, 100682, ISSN 2772-9303, https://doi.org/10.1016/j.jscai.2023.100682.
Citation to related work
Elsevier
Has part
Journal of the Society for Cardiovascular Angiography & Interventions, Vol. 2, Iss. 3, Supp.
ADA compliance
For Americans with Disabilities Act (ADA) accommodation, including help with reading this content, please contact scholarshare@temple.edu