G Ital Cardiol (Rome). 2026 Aug;27(8):551-558. doi: 10.1714/4741.47566.
ABSTRACT
BACKGROUND: Cardiogenic shock is a critical condition with a short-term mortality rate of around 40-50%, which has remained unchanged over the years despite therapeutic advances in acute cardiac diseases. In this context, the use of microaxial flow pumps is increasing and in the DanGer Shock trial it reduced the 6-month mortality in patients with cardiogenic shock due to acute myocardial infarction compared to standard therapy. The aim of this study was to evaluate how the use of microaxial flow pump in our population of patients with cardiogenic shock impacted survival and short- and mid-term outcomes.
METHODS: We retrospectively collected data from 78 patients with cardiogenic shock treated with microaxial flow pump and admitted to the Cardiac Intensive Care Unit of Ospedali Riuniti of Ancona, Italy, between April 2014 and December 2024. The primary end-point was the assessment of independent predictors of in-hospital mortality, while the secondary end-point was a composite end-point (all-cause death, rehospitalization for heart failure, acute coronary syndrome, arrhythmias, heart transplantation, or ventricular assist device implantation at 12-month follow-up).
RESULTS: Mean age of the population was 59.3 years, predominantly of male sex. The mean left ventricular ejection fraction at admission was 24.2%, mean serum lactate level at admission was 5.8 mmol/l. In 17 patients, Impella mechanical circulatory support represented an escalation therapy from intra-aortic balloon pump. In-hospital mortality was 32.1%, and variables such as age, left ventricular ejection fraction at intensive care unit admission, and the presence of right ventricular dysfunction were associated with higher in-hospital mortality. The secondary end-point occurred in 7 patients (8.9%): 3 patients died and 4 patients were rehospitalized for cardiovascular causes within 12 months after discharge.
CONCLUSIONS: Impella circulatory support is a device capable of "resting" the ventricular myocardium while ensuring adequate cardiac output. In our observational evaluation, the use of Impella was associated with a reduction in in-hospital mortality. However, optimal timing of implantation remains to be clarified to maximize its benefit and avoid futile use.
PMID:42522435 | DOI:10.1714/4741.47566