| Sažetak | Objectives: This study sought to describe the initial experiences, clinical features, safety, and
effectiveness of Impella CP® hemodynamic support for cardiogenic shock (CS) and high risk
percutaneous coronary intervention (HR-PCI). Specific goals were to evaluate baseline
characteristics, comorbidities, laboratory markers, echocardiographic findings, complications,
in-hospital, and procedure-related mortality.
Materials and methods: This retrospective study was conducted at the Clinic for
Cardiovascular Diseases, University Hospital of Split from October 2022 to April 2024 and
involved patients treated with Impella CP®. Data were collected from the hospital information
system. Variables included laboratory, echocardiographic and angiographic findings, clinical
and procedural characteristics, and in-hospital outcomes and mortality. Standard descriptive
methods were used, and inferential analyses avoided due to the small sample size.
Results: The study involved 16 patients in two groups: CS group (N=6) and HR-PCI group
(N=10). Most patients had previously diagnosed arterial hypertension (75%). ST elevation
myocardial infarction (STEMI) was more common in the CS (83.3%) compared to the HR-PCI
group (10%). Non-ST elevation myocardial infarction (NSTEMI) was present in 60% of HRPCI
patients but rare in the CS group (16.7%). All HR-PCI patients and 66.7% of CS patients
had multivessel disease. Most CS patients required mechanical ventilation (83.3%) and
inotropes or vasopressors (83.3%). PCI of LM was performed in 70% of patients in the complex
HR-PCI group. Half of patients in the complex HR-PCI group (50%) and 1/3 of patients in the
CS group (33.3%) underwent PCI of the left circumflex artery (Cx). PCI of the right coronary
artery (RCA) was performed in half of the patients in the HR-PCI group (50%). 3- vessel PCI
was only performed in one CS patient (16.7%) but in 60% of complex HR-PCI patients. The
mean time on Impella CP® support in the complex HR-PCI group was 4.3±6.9 hours and
33±38.2 hours in the CS group. The mean length of hospital stay was 14 days in the HR-PCI
group and 8.2 days in the CS group. In the CS group complications included vascular
complications in one patient (16.7%), critical limb ischemia in 16.7% of patients and the need
for RRT in 50% of patients. In the complex HR-PCI group complications were rare. Death
occurred in half of CS patients (50%), but in none of the complex HR-PCI patients.
Conclusions: Impella CP® device is a feasible, safe, and effective option in the management
of CS and protected HR-PCI. The procedural success rate was high, with minimal procedure related
complications observed and no procedure-related mortality. |
| Sažetak (hrvatski) | Ciljevi: Ova studija je imala za cilj opisati početna iskustva, kliničke značajke, sigurnost i
učinkovitost hemodinamske potpore Impella CP® kod kardiogenog šoka (CS) i visokorizične
perkutane koronarne intervencije (HR-PCI). Specifični ciljevi bili su procijeniti osnovne
karakteristike, komorbiditete, laboratorijske markere, ehokardiografske nalaze, komplikacije,
bolničku smrtnost i smrtnost povezanu s postupkom.
Materijali i metode: Ova retrospektivna studija provedena je na Klinici za kardiovaskularne
bolesti, Klinički bolnički centar Split od listopada 2022. do travnja 2024. godine i uključivala
je pacijente liječene Impella CP® uređajem. Podaci su prikupljeni iz bolničkog informacijskog
sustava. Varijable su uključivale laboratorijske, ehokardiografske i angiografske nalaze,
kliničke i proceduralne karakteristike te bolničke ishode i smrtnost. Korištene su standardne
deskriptivne metode, a inferencijalne analize su izbjegnute zbog malog uzorka.
Rezultati: Studija je uključivala 16 pacijenata u dvije skupine: CS skupina (N=6) i HR-PCI
skupina (N=10). Većina pacijenata imala je prethodno dijagnosticiranu arterijsku hipertenziju
(75%). ST elevacijski infarkt miokarda bio je češći u CS skupini (83,3%) u usporedbi s HRPCI
skupinom (10%). Non-ST elevacijski infarkt miokarda bio je prisutan kod 60% pacijenata
u HR-PCI skupini, ali rijedak u CS skupini (16,7%). Svi HR-PCI pacijenti i 66,7% CS
pacijenata imali su višežilna koronarna bolest. Većina CS pacijenata zahtijevala je mehaničku
ventilaciju (83,3%) i inotrope ili vazopresore (83,3%). PCI debla izveden je kod 70% pacijenata
u HR-PCI skupini. Polovica pacijenata u HR-PCI skupini (50%) i 1/3 pacijenata u CS skupini
(33,3%) podvrgnuta je PCI lijeve cirkumfleksne arterije (Cx). PCI desne koronarne arterije
(RCA) izveden je kod polovice pacijenata u HR-PCI skupini (50%). PCI na tri krvne žile
izveden je samo kod jednog CS pacijenta (16,7%), ali kod 60% pacijenata u HR-PCI skupini.
Prosječno vrijeme podrške Impella CP® uređajem u HR-PCI skupini bilo je 4,3±6,9 sati, a u
CS skupini 33±38,2 sati. Prosječna duljina boravka u bolnici bila je 14 dana u HR-PCI skupini
i 8,2 dana u CS skupini. Komplikacije u CS skupini uključivale su vaskularne komplikacije kod
jednog pacijenta (16,7%), kritičnu ishemiju uda kod 16,7% pacijenata i potrebu za
hemodijalizom kod 50% pacijenata. Komplikacije su bile rijetke u HR-PCI skupini. Smrt se
dogodila kod polovice CS pacijenata (50%), ali kod nijednog pacijenta u HR-PCI skupini.
Zaključci: Impella CP® uređaj je izvediva, sigurna i učinkovita opcija u upravljanju
kardiogenim šokom i zaštićenim HR-PCI. Stopa uspješnosti postupka bila je visoka, s
minimalnim komplikacijama povezanim s postupkom i bez smrtnosti povezane s postupkom. |
