Concerns for the Use of Impella in Patients with Cardiogenic Shock Complicating Acute Myocardial Infarction

Introduction: To our knowledge, there has been no conclusive evidence so far to guide the choice betweenimpella and intra-aortic balloon pump (IABP) in patients with ischemic cardiogenic shock. Using the 2016 NationalInpatient Sample (NIS), this work aims to compare in-hospital outcomes among patients presenting with ischemiccardiogenic shock treated without mechanical support, with impella, or with IABP.Methods: Data was obtained from the 2016 NIS database. The primary outcome was in-patient mortality.Secondary outcomes were hospital length of stay and total hospital charge. A series of univariate and multivariateregression analyses were conducted on STATA 15.1.Results: In this dataset, 11710 observations met the criteria of adults, acute ischemia and cardiogenic shock.Among these, 7727 were treated without mechanical support, 649 were treated with impella, and 3,334 were treatedwith IABP. Patients treated with impella had higher inpatient mortality (OR 1.75; 95% CI 1.46 - 2.11), whereas patienttreated with IABP had lower inpatient mortality (OR 0.77; 95% CI 0.70 - 0.85). In addition, compared with nomechanical support and IABP, the use of impella was associated with higher hospital cost (β1=198269, p<0.001).Furthermore, the use of impella was not associated with change in length of stay when compared to no mechanicalsupport. IABP was associated with longer length of stay (β1=1.53, p<0.001).Conclusion: In conclusion, among patients was ischemic cardiogenic shock, compared with no mechanicalsupport, inpatient mortality was higher with impella and lower with IABP use. In addition, impella use was associatedwith increase hospital cost without change in hospital length of stay. Lastly, IABP was associated with increasedlength of stay. Despite the limitations of the NIS dataset, including selection bias, this work should prompt furtherresearch to validate the use impella.