J Heart Lung Transplant. 2026 Apr 9:S1053-2498(26)01826-7. doi: 10.1016/j.healun.2026.03.036. Online ahead of print.
ABSTRACT
BACKGROUND: Microaxial flow pumps (mAFP) are increasingly used to treat cardiogenic shock (CS), but most evidence comes from acute myocardial infarction-related CS (AMI-CS). It remains unclear whether patients with non-ischemic CS (Non-AMI-CS) derive comparable benefits from mAFP support. This study aimed to compare clinical profiles, management strategies, and outcomes between AMI-CS and Non-AMI-CS patients treated with mAFP.
METHODS: We retrospectively analyzed CS patients managed with mAFP (Impella CP and 5 + [5.0 and 5.5]) across 11 high-volume centers between 2010 and 2023. Propensity score matching was performed to account for baseline differences. The primary outcome was all-cause mortality at 180 days. Independent predictors of mortality were identified using multivariable logistic regression analysis.
RESULTS: A total of 976 patients were included (64.0% AMI-CS; 36.0% Non-AMI-CS). From 2010 to 2023, 180-day mortality significantly declined in both groups (Ptrend = 0.01 for AMI-CS and 0.03 for Non-AMI-CS). After propensity score matching (n = 444), 180-day mortality was comparable between AMI-CS and Non-AMI-CS patients (32.9% vs 33.3%; HR 0.89 [95% CI, 0.65-1.21]; p = 0.46). Rates of heart transplantation (5.0% vs 9.0%; p = 0.08) and durable LVAD implantation (10.8% vs 9.0%; p = 0.77) were also similar. These findings were consistent across all prespecified subgroups and at 10-year follow-up. Independent predictors of mortality in both groups included age (per 5-year increase), SCAI stage E, lactate ≥6 mmol/L), norepinephrine use, and renal replacement therapy. Despite similar survival, Non-AMI-CS patients demonstrated greater myocardial recovery, with larger LVEF improvement (+17.8 ± 17.0% vs +11.2 ± 14.5%; p < 0.001).
CONCLUSIONS: In this large, real-world cohort, ischemic and non-ischemic CS showed equivalent long-term outcomes under mAFP support. These findings suggest that patient selection should be guided by shock severity and hemodynamic phenotype rather than etiology alone, supporting broader evaluation of mAFP use.
PMID:41966345 | DOI:10.1016/j.healun.2026.03.036