Outcomes of Hemodynamic Support With Impella for Acute Myocardial Infarction Complicated by Cardiogenic Shock at a Rural Community Hospital Without On-Site Surgical Back-up.

Impella 2.5 and Impella CP (Abiomed) are percutaneous left ventricular assist devices that can be easily deployed in the cardiac catheterization laboratory without need for surgery and provide effective hemodynamic support. The utility of Impella devices for management of acute myocardial infarction complicated by cardiogenic shock (AMI-CS) at a rural community hospital without on-site surgical back-up has not been reported. We retrospectively reviewed all consecutive patients who underwent percutaneous coronary intervention (PCI) with Impella support between 2012 and 2017 for AMI-CS at our institution. Survival, in-hospital complications, and recovery of native heart function at follow-up were assessed. A total of 90 consecutive patients (age, 63.8 ± 11.56 years; 28.8% female) with AMI-CS were supported with Impella and underwent PCI. At admission, 82.2% had cardiogenic shock and 32.2% sustained out-of-hospital cardiac arrest (OHCA). Survival rates at discharge, 30 days, 180 days, and 365 days were 61.1%, 60.0%, 57.7%, and 57.3%, respectively. Survivors were younger (P=.02) and had lower rates of OHCA (P<.01). Survival rate at 180 days was 72.4% when door-to-Impella support time was ≤48 minutes, 53.9% when Impella was initiated between 49 to 86 minutes, and 39.3% when Impella support was initiated after 86 minutes (P=.04). Recovery of native heart function was observed in 88.7% of 62 patients weaned off Impella support. Early hemodynamic support with the Impella percutaneous left ventricular assist device in severely ill patients with AMI-CS at a rural community hospital without on-site surgical back-up yielded very favorable survival outcomes, with recovery of native heart function.