Women With Cardiogenic Shock Derive Greater Benefit From Early Mechanical Circulatory Support: An Update From the cVAD Registry

Joseph, Susan; Brisco, Meredith A.; Colvin, Monica; Grady, Kathleen L.; Walsh, Mary Norine; Cook, Jennifer

doi:10.1111/joic.12298

Cited by 59 publications

(58 citation statements)

References 28 publications

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“…We report in our study inhospital complications rates similar to previous reports of Impella 2.5 pLVAD use in AMICS. 15,18 In this dataset, hemolysis rate of 5.6%, bleeding requiring transfusion rate of 2.3%, vascular complications requiring surgery rate of 2.3% and device malfunction rate of 2.3% were all low. Longer dwell times for pLVAD has been associated with more hemolysis as seen in the EuroShock and cVAD registries, however, those patient cohorts demonstrated higher rates than in our patient population with a similar mean device dwell time.…”

Section: Discussionmentioning

confidence: 77%

“…15 These extended DTB times in the pre-PCI group were not a determinant of adverse outcomes while on the contrary had significantly better mortality. 15,18,27 The concept of door-to-support or door-to-unloading time needs to be the new metric for patients presenting with AMI complicated with CS. This dataset has all the limitations inherent to a retrospective study.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Impella 2.5 initiated prior to unprotected left main PCI in acute myocardial infarction complicated by cardiogenic shock improves early survival

Meraj

Doshi

Schreiber

et al. 2017

J Interven Cardiology

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Impella 2.5 initiated prior to unprotected left main PCI in acute myocardial infarction complicated by cardiogenic shock improves early survival

Meraj

Doshi

Schreiber

et al. 2017

J Interven Cardiology

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show abstract

“…Of note, a prior study among patients with cardiogenic shock by Joseph et al, demonstrated that female patients derived a greater benefit from Impella supported high-risk PCI. 28 Females are known to have higher risk of access site complications and the use of transradial route in percutaneous coronary intervention has been shown to reduce access site bleeding. 29 Although females had lower baseline hemoglobin and experienced more bleeding that required blood transfusion they were not at increased risk of vascular complications compared with males.…”

Section: Discussionmentioning

confidence: 99%

Sex‐related difference in the use of percutaneous left ventricular assist device in patients undergoing complex high‐risk percutaneous coronary intervention: Insight from the cVAD registry

Alraies

Kaki

Kajy

et al. 2019

Cathet Cardio Intervent

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Objective To assess the in‐hospital and short‐term outcome differences between males and females who underwent high‐risk PCI with mechanical circulatory support (MCS). Background Sex differences have been noted in several percutaneous coronary intervention (PCI) series with females less likely to be referred for PCI due increased risk of adverse events. However, data on sex differences in utilization and outcomes of high‐risk PCI with MCS is scarce. Methods Using the cVAD Registry, we identified 1,053 high‐risk patients who underwent PCI with MCS using Impella 2.5 or Impella CP. Patients with cardiogenic shock were excluded. A total of 792 (75.21%) males and 261 (24.79%) females were included in the analysis with median follow‐up of 81.5 days. Results Females were more likely to be African American, older (72.05 ± 11.66 vs. 68.87 ± 11.17, p < .001), have a higher prevalence of diabetes (59.30 vs. 49.04%, p = .005), renal insufficiency (35.41 vs. 27.39%, p = .018), and peripheral vascular disease (31.89 vs. 25.39%, p of .05). Women had a higher mean STS score (8.21 ± 8.21 vs. 5.04 ± 5.97, p < .001) and lower cardiac output on presentation (3.64 ± 1.30 vs. 4.63 ± 1.49, p < .001). Although women had more comorbidities, there was no difference in in‐hospital mortality, stroke, MI or need for recurrent revascularization compared to males. Females were more likely to have multivessel revascularization than males. Ejection fraction improved in both males and females at the time of discharge (26.59 to 31.40% and 30.75 to 36.05%, respectively, p < .0001). However, females had higher rate of bleeding requiring transfusion compared with males (9.58 vs. 5.30%, p = .019). Conclusion Female patients undergoing high PCI were older and had more comorbidities but had similar outcomes compared to males.

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“…Interestingly, there seems to be differences in survival in-between men and women. Data from the cVAD registry (catheter-based ventricular assist device registry), a database retrospectively enrolling patients that underwent pVAD support with Impella®, showed that early initiation of hemodynamic support in patients with AMI complicated by CS was associated with a greater survival benefit in women compared to men [20]. These data are encouraging, as women usually suffer higher unadjusted mortality rates and experience the use of guideline-recommended therapies to a lesser extent.…”

Section: Cardiogenic Shockmentioning

confidence: 98%

Peripheral Ventricular Assist Devices in Interventional Cardiology: The Impella® Micro-Axial Pump

Becher¹,

Baumann²,

Eder³

et al. 2017

Interventional Cardiology

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Coronary artery disease (CAD) presents an ever-growing burden on health systems especially in the Western world. While percutaneous coronary intervention (PCI) is feasible in increasingly complex CAD, certain patient groups possess a high risk for major cardiac adverse events (MACE) during PCI. Poor outcome is associated with significantly depressed left ventricular function, complexity of relevant lesions, and increasing incidence of pre-existing cerebrovascular comorbidities and poor pre-interventional status. However, these risk factors also translate into a high peri-operative risk for coronary artery bypass graft (CABG) rendering some of these patients inoperable. Peripheral ventricular assist devices (pVADs) are temporarily inserted axial or centrifugal pumps that support ventricular output during PCI. The Impella® micro-axial device (Abiomed, Danvers, Massachusetts, USA) is an easily implantable pVAD that may improve patient outcome during PCI in high-risk patients (termed "protected PCI") and in patients with cardiogenic shock (CS). pVADs in general and the Impella® system in particular play important roles in interventional cardiology and its indications and use will likely expand in the future. This chapter outlines in detail the indications, applications, and future trends concerning the Impella® system. Practical advice is given on the correct implantation of the device.

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Women With Cardiogenic Shock Derive Greater Benefit From Early Mechanical Circulatory Support: An Update From the cVAD Registry

Cited by 59 publications

References 28 publications

Impella 2.5 initiated prior to unprotected left main PCI in acute myocardial infarction complicated by cardiogenic shock improves early survival

Impella 2.5 initiated prior to unprotected left main PCI in acute myocardial infarction complicated by cardiogenic shock improves early survival

Sex‐related difference in the use of percutaneous left ventricular assist device in patients undergoing complex high‐risk percutaneous coronary intervention: Insight from the cVAD registry

Peripheral Ventricular Assist Devices in Interventional Cardiology: The Impella® Micro-Axial Pump

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