J Thorac Cardiovasc Surg. 2026 Jan 16:S0022-5223(26)00019-X. doi: 10.1016/j.jtcvs.2025.12.034. Online ahead of print.
ABSTRACT
OBJECTIVE: Impella micro-axial pumps are increasingly used in cardiogenic shock (CS). Recent randomized-controlled data showed a survival benefit with use of the Impella CP in STEMI-related CS. Use of the Impella 5.5, a high-flow surgically implanted micro-axial pump, in acute myocardial infarction (AMI) CS patients remains largely unexplored. We analyzed data from the Surgical Unloading Renal Protection and Sustainable Support (SURPASS) study, a prospective, multi-center, observational registry evaluating real-world outcomes in AMI-CS patients supported with Impella 5.5.
METHODS: Patients with CS enrolled in SURPASS at 15 sites between August 2020 and December 2023 were included and stratified into those receiving Impella 5.5 only versus other non-ECMO forms of temporary mechanical devices prior to or during Impella 5.5 (Impella 5.5+Other tMCS). In this analysis, veno-arterial and veno-venous extracorporeal membrane oxygenation patients were excluded. In hospital outcomes and longitudinal survival were studied, specifically adverse events while on support, and survival at hospital discharge, 30-day and 1-year.
RESULTS: Among 177 AMI-CS patients, 31% (n=55) received only an Impella 5.5 and 69% (n=122) received Impella 5.5+Other tMCS. Mean age was 61±12 years and 80% of subjects were male. Comorbidities included: diabetes (49%), hypertension (67%), heart failure (34%), peripheral vascular disease (17%) and previous stroke (8%). Overall in-hospital survival was 65% with higher survival among Impella 5.5-only patients (75% vs 61%, p=0.089). Among all survivors 78% had native heart survival, 4% underwent heart transplant, and 11% underwent durable left ventricular assist device placement. Adverse events while on support included stroke (4%), hemolysis (9%), all-cause bleeding (16%) and acute kidney injury (23%). Hemolysis was lower among Impella 5.5-only patients (1.8% vs 12.3%, p<0.05). The 30-day survival was 81.7% for the Impella 5.5 alone group and 66.0% for the Impella 5.5+tMCS group (p = 0.044), 6-month survival 64.8% vs. 51.8% (p = 0.081), and 12-month survival 58.0% vs. 46% (p = 0.090).
CONCLUSIONS: There is considerable variation in how Impella 5.5 is used to treat patients with AMI-CS, with a majority of patients being exposed to other forms of tMCS. Majority of patients were discharged on their native heart, and patients supported with Impella 5.5-only had trend towards higher survival and significantly lower all-cause bleeding, hemolysis, and stroke rates.
PMID:41548842 | DOI:10.1016/j.jtcvs.2025.12.034