Temporary Mechanical Circulatory Support Strategy in Patients With AMI-Related Cardiogenic Shock Receiving Veno-Arterial Extracorporeal Life Support and Impella (ECPELLA) in Japan

The prognosis in patients with acute myocardial infarction-related cardiogenic shock (AMI-CS) receiving veno-arterial extracorporeal life support (VA-ECLS) and Impella ( ie , ECPELLA) support remains unsatisfactory. The difference in therapeutic strategy and mortality between left ventricular assist device (LVAD) and non-LVAD centers remains unknown, especially in Japan. Patients with AMI-CS who received Impella support between 2020 and 2023 were prospectively registered in the Japanese registry for Percutaneous Ventricular Assist Device (J-PVAD). The difference in 30 day mortality in patients receiving ECPELLA support between LVAD and non-LVAD centers was retrospectively investigated. A total of 1,549 patients (median 69 years; LVAD center 21.1%) were included. The prevalence of Impella upgrade and LVAD implantation was significantly higher in LVAD center than non-LVAD center. The 30 day mortality was lower in LVAD center than non-LVAD center (45.5% vs . 54.5%, p = 0.002). Multivariable analysis demonstrated that LVAD center and Impella upgrade were independent predictors for lower 30 day mortality with adjusted hazard ratios of 0.791 (95% confidence interval: 0.658-0.953, p = 0.013) and 0.483 (95% confidence interval: 0.339-0.690, p < 0.001), respectively, instead of LVAD implantation. Impella upgrade was more frequent in LVAD center and associated with a lower 30 day mortality among patients with AMI-CS receiving ECPELLA support.