Long-term 5-year outcome of the randomized IMPRESS in severe shock trial: percutaneous mechanical circulatory support vs. intra-aortic balloon pump in cardiogenic shock after acute myocardial infarction. Issue 9 (29th July 2021)

• Record Type: Journal Article
• Authors: Karami, Mina; Eriksen, Erlend; Ouweneel, Dagmar M; Claessen, Bimmer E; Vis, M Marije; Baan, Jan; Beijk, Marcel; Packer, Erik J S; Sjauw, Krischan D; Engstrom, Annemarie; Vlaar, Alexander; Lagrand, Wim K; Henriques, Jose P S
• Is Part Of: European heart journal. Volume 10:Issue 9(2021)
• Page Start: 1009
• Page End: 1015
• Publication Date: 2021-07-29
• Subjects: Cardiogenic shock -- Mechanical circulatory support -- Acute myocardial infarction -- Randomized controlled trial -- Intra-aortic balloon pump; 616.1205
• DOI: 10.1093/ehjacc/zuab060
• Languages: English
• ISSNs: 2048-8726

Abstract

Abstract: Aims: To assess differences in long-term outcome and functional status of patients with cardiogenic shock (CS) treated by percutaneous mechanical circulatory support (pMCS) and intra-aortic balloon pump (IABP). Methods and results: Long-term follow-up of the multicentre, randomized IMPRESS in Severe Shock trial (NTR3450) was performed 5-year after initial randomization. Between 2012 and 2015, a total of 48 patients with severe CS from acute myocardial infarction (AMI) with ST-segment elevation undergoing immediate revascularization were randomized to pMCS by Impella CP ( n = 24) or IABP ( n = 24). For the 5-year assessment, all-cause mortality, functional status, and occurrence of major adverse cardiac and cerebrovascular event (MACCE) were assessed. MACCE consisted of death, myocardial re-infarction, repeat percutaneous coronary intervention, coronary artery bypass grafting, and stroke. Five-year mortality was 50% ( n = 12/24) in pMCS patients and 63% ( n = 15/24) in IABP patients (relative risk 0.87, 95% confidence interval 0.47–1.59, P = 0.65). MACCE occurred in 12/24 (50%) of the pMCS patients vs. 19/24 (79%) of the IABP patients ( P = 0.07). All survivors except for one were in New York Heart Association Class I/II [pMCS n = 10 (91%) and IABP n = 7 (100%), P = 1.00] and none of the patients had residual angina. There were no differences in left ventricular ejection fraction between the groups (pMCS 52 ± 11% vs. IABP 48 ± 10%, P = 0.53). Conclusions: In this explorative randomized trial of patients with severe CS after AMI, there was no difference in long-term 5-year mortality between pMCS and IABP-treated patients, supporting previously published short-term data and in accordance with other long-term CS trials. Graphical Abstract: