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U MICHIGAN EPERIENCE 1983-1985
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Cardiogenic Shock Complicating Acute Myocardial Infarction
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1. Dhaval Kolte et al. J Am Heart Assoc 2014 NATIONWIDE INPATIENT SAMPLE2. Centers for Medicare and Medicaid database, MEDPAR FY14
INCIDENCE OF CARDIOGENIC SHOCK GROWING
STEMI Cardiogenic Shock inMedicare Age Increasing 2
Cardiogenic Shock inS
2010 2014
Age >65 only, excludes non-Medicare population
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LIMITATIONS OF CONVENTIONAL THERAPY
1- Samuels LE et al , J Card Surg. 19992- Thiele H et al. NEJM 2012 - Clinicaltrial.gov # NCT00491036
IABP-SHOCK IIRandomized Controlled Trial2
N = 600
Mortality Risk withInotropes/Vasopressors1
N = 40
Inotrope Harm in Cardiogenic Shock
1. Marked increase in MVO2 at a time of oxygen starvation.
2. Tachycardia increases MVO2 and decreases diastolicinterval.
3. Marked increase in LVEDP causes further decrease indiastolic perfusion pressure and increased wall tension.
4. Tachycardia mediated apoptosis may decrease myocardialrecovery.
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HEMODYNAMIC EFFECTS OF IMPELLA SUPPORT
Fincke J, et al. Am Coll Cardiol 2004
den Uil CA, et al. Eur Heart J 2010
Mendoza DD, et al. AMJ 2007
Torgersen C, et al. Crit Care 2009
Torre-Amione G, et al. J Card Fail 2009
Suga H. et al. Am J Physiol 1979
Suga H, et al. Am J Physiol 1981
Burkhoff D. et al. Am J Physiol Heart Circ 2005
Burkhoff D. et al. Mechanical Properties Of The Heart And ItsInteraction With The Vascular System. (White Paper) 2011
Sauren LDC, et al. Artif Organs 2007
Meyns B, et al. J Am Coll Cardiol 2003
Remmelink M, et al. atheter.Cardiovasc Interv 2007
Aqel RA, et al. J Nucl Cardiol 2009
Lam K,. et al. Clin Res Cardiol 2009
Reesink KD, et al. Chest 2004
Valgimigli M, et al.Catheter Cardiovasc Interv 2005
Remmelink M. et al. Catheter Cardiovasc Interv 2010
Naidu S. et al. Novel Circulation.2011
Weber DM, et al. Cardiac Interventions Today Supplement Aug/Sep 2009
tal
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IMPELLA REDUCES NEED FOR INOTROPES/PRESSORS
RECOVER I FDA IDE Study2
(N=16)ISAR-SHOCK RCT1
N=25
Impella 2.5Reduction in Inotropes/Pressors
in 24 Hours
Impella 5.0Reduction in Inotropes/Pressors
Over days
1- Seyfarth et al. JACC 20082- Griffith et a. J Thorac Cardiovasc Surg 2012
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The catheter based VAD Registry is a worldwide observational clinical registry designed to monitor patientsafety and real-world outcomes of patients supported with Impella 2.5/CP/5.0/LD/RP
THE CVAD REGISTRY: A GLOBAL INITIATIVE
Impella Approved: USA, Canada, Panama, Colombia, Venezuela, Brazil, Portugal, Spain, France, Italy, Greece, Switzerland, Austria, Germany, Belgium, Luxemburg, Netherland, Ireland, UK, Denmark, Norway, Sweden, Finland, Russia, China, SaudiArabia, Kuwait
Impella Approved and cVAD Registry Active: USA, Canada, Spain, France, Italy, Switzerland, Germany, Netherland, UK, Denmark
Basir, O’Neill, et al. TCTAbstract 121 (2016)
Basir, O’Neill, et al. TCTAbstract 121 (2016)
Basir, O’Neill, et al. TCTAbstract 121 (2016)
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DETROIT CARDIOGENIC SHOCK INITIATIVE DETROITCSI
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Pre-Impella Post-Impella
DETROITCSI Observations
1. MCScan be initiated in a majority of patientswithin 60 minutesifarrival.
2. Door to support may become a quality marker for shockmanagement.
3. Most patientshave inotropicsupport eliminated or markedlyreduced before cath lab discharge.
4. Cardiacpower output >0.6 wattscan be achieved in all patientsprior to cath lab discharge.
5. Promising trends in coronary perfusion and survival ( 80 %hospital survival) exist.
CARDIOGENIC SHOCKA CHANGE IN PARADIGM
DOOR TO BALLOON DOOR TO SUPPORT
CARDIOGENIC SHOCK OUTCOME EUROPEAN EECMOExperience
EuroIntervention 2016
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