2024-12-182024-12-182023-05-18Yaser 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.2023.100682.2772-9303http://hdl.handle.net/20.500.12613/10803Background: 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.2 pagesengAttribution-NonCommercial-NoDerivs CC BY-NC-NDhttps://creativecommons.org/licenses/by-nc-nd/4.0/Text