National Trends in Impella Utilization for Older Adult Patients With ST-Elevation Myocardial Infarction Complicated by Cardiogenic Shock

<h2>Abstract:</h2><h3>Background</h3> Current guidelines recommend implantation of a microaxial flow pump (mAFP) for selected STEMI patients with Cardiogenic Shock (STEMI-CS). While the DanGer Shock trial showed a mortality benefit with mAFP, a secondary analysis suggested that elderly patients may not experience the same benefit. This study evaluated temporal trends in mAFP utilization and hospital mortality in elderly (≥75 years) vs. non-elderly STEMI-CS patients. <h3>Methods</h3> Using ICD-10 procedure codes from 344 hospitals with continuous data between 2016-2024 from the Vizient® Clinical Data Base, we identified 20,692 patients undergoing PCI for STEMI-CS. Temporal trends in mAFP use and mortality were stratified by elderly vs. non-elderly age groups. Multivariable logistic regressions identified predictors of hospital mortality. <h3>Results</h3> Among 20,692 STEMI-CS patients undergoing PCI, 25% were elderly. Older age was the strongest independent predictor of hospital mortality for STEMI-CS patients (OR 1.87; CI 1.75-2.00). Between 2016 and 2024, mAFP use for STEMI-CS increased from 9.3% to 21.5% in the elderly and from 14% to 25.6% in patients <75 years old (p-value for trend=0.05 and 0.02 respectively). Mortality declined in mAFP patients < 75 years old: 45% in 2016 vs. 38% in 2024; p=0.003. The mortality rate for elderly PCI patients with STEMI-CS and mAFP utilization was consistently above 50%. <h3>Conclusions</h3> Approximately 1 in 5 elderly STEMI-CS patients received mAFP, with use more than doubling since 2016. While mortality declined significantly in mAFP-treated non-elderly STEMI-CS PCI patients; mortality in the elderly remained approximately 60% higher than non-elderly patients at all time points