The Duration of Impella 2.5 Circulatory Support and Length of Hospital Stay of Patients Undergoing High-risk Percutaneous Coronary Interventions

Abstract

BackgroundTo evaluate the impact of duration of Impella 2.5 support (Abiomed, Danvers, MA) on hospitalization of patients after high-risk percutaneous coronary intervention (PCI). There has been a continuous increase in prevalence of coronary artery disease with more patients needing PCI during acute myocardial infarction. Some of these patients have to undergo high-risk revascularization with circulatory support like the Impella 2.5 device.MethodsThis study was a single center retrospective study of patients admitted to our hospital who required Impella circulatory support during percutaneous coronary intervention. Patients’ medical records, cardiac catheterization laboratory and 2-D echocardiography reports were reviewed to ascertain left ventricular ejection fraction, duration of Impella support, Coronary Care Unit (CCU) days and the length of stay in the hospital. A P-value of ≤ 0.05 was considered statistically significant.ResultsOver a 15-month period, we had 25 patients with 19 males and 6 females. Mean age of the patient cohort was 68 ± 10 years. Mean LVEF of the group was 32 ± 16%. Mean length of hospital stay was 8 ± 8 days and mean CCU stay was 4 ± 4 days. The Impella was successfully inserted in all cases with a median duration of support of 70 minutes (range, 4 - 5760 minutes). Bleeding complication occurred in 8%. Spearman's rank correlation coefficient between the duration of Impella support and hospital stay was 0.49 (P = 0.023) while it was 0.71 (P = 0.001) between Impella support duration and CCU days.ConclusionsOur study suggests that there is a positive correlation between the duration of Impella 2.5 circulatory support and hospital stay and/or CCU days. The correlation seems to be stronger with CCU days.

The effectiveness and safety of the Impella ventricular assist device for high‐risk percutaneous coronary interventions: A systematic review

“…However, neither reached statistical significance due to their modest sample sizes. In most uncontrolled studies, the 30‐day rates of all‐cause mortality were generally low; ranging from 3.7% to 10% (Table ). Higher rates were observed in the cohort studies by Engstrom et al , Henriques et al , Venugopal et al , and O'Neill et al (74%, 21%, 18%, and 42.6%, respectively), likely due to differences in study population.…”

“…The 20 studies consisted of 4 RCTs [5,6,26,27] and 16 observational studies [7,8,[12][13][14][15][16][17][18][19][20][21][22][23][24][25], including a total of 1,287 patients ( Table 1). All studies were published between 2006 and 2016, and the durations of follow-up ranged from 1 to 42 months.…”

“…All studies were published between 2006 and 2016, and the durations of follow-up ranged from 1 to 42 months. Ten studies examined prophylactic use of the Impella device among high-risk patients undergoing elective PCI [6,7,12,14,16,18,21,22,24,25], 5 examined its use among high-risk patients undergoing emergent PCI [5,8,13,20,26,27], and 4 examined its use in mixed populations of high-risk patients undergoing elective or emergent PCI [15,17,19,23]. The 4 RCTs contained a total of 438 patients; 1 RCT compared the Impella device to IABP in highrisk patients with left main disease or multivessel disease undergoing elective PCI [6], while 2 RCTs compared the use of the Impella device and IABP in the setting of emergent PCI in patients with cardiogenic shock and MI [5,27].…”

“…Finally, the IMPRESS in STEMI trial [26] compared Impella with IABP after primary PCI but was stopped prematurely due to insufficient follow-up. The 15 observational studies included 2 controlled studies that compared Impella with IABP [23,24] and 13 uncontrolled studies [7,8,12,[14][15][16][17][18][19][20][21][22]25].…”

“…Several studies have examined the effectiveness and safety of the Impella device . However, many of these studies were small and produced inconclusive results.…”