Association Between Impella Device Type and Short-Term Prognosis in Patients with Acute Myocardial Infarction-Related Cardiogenic Shock Receiving ECPELLA Support Preliminary Insights from the J-PVAD Registry

The prognosis in patients with acute myocardial infarction-related cardiogenic shock (AMI-CS) remains unsatisfactory even in the era of Impella, especially among the patients who receive concomitant veno-arterial extracorporeal membrane oxygenation (ECMO) support (i.e., ECPELLA). The prognostic impact of Impella device type in patients with AMI-CS receiving ECPELLA support remains uncertain. Patients with AMI-CS who had received Impella-incorporated temporary mechanical circulatory support between 2020 and 2022 were prospectively registered in the Japanese Registry for Percutaneous Ventricular Assist Device (J-PVAD). The prognostic impact of Impella device type on the 30-day mortality in patients receiving ECPELLA therapy was retrospectively investigated. A total of 996 patients receiving ECPELLA therapy (median 69 years; out-of-hospital cardiac arrest 36.8%; lactate 8.2 mmol/L) were included. The device type of Impella 5.0/5.5 (n = 73) was associated with a lower 30-day mortality with an adjusted hazard ratio of 0.575 (95% confidence interval 0.369-0.895, P = 0.0143) and a lower 30-day cumulative mortality (35.6% versus 56.8%, P = 0.0002) compared with the Impella 2.5/CP (n = 923). Among the patients with AMI-CS receiving ECPELLA support, Impella 5.0/5.5 use was significantly associated with a lower 30-day mortality compared with smaller Impella devices. Implementing an Impella 5.5 or Impella upgrade from CP to 5.5 may improve the short-term prognosis in patients with advanced AMI-CS who are receiving ECPELLA support.