Use of Impella CP in cardiogenic shock due to ST-segment elevation myocardial infarction: are the results of the DanGer Shock study comparable to clinical practice?

The management of cardiogenic shock (CS) following ST-segment elevation myocardial infarction (STEMI) remains a challenge. The DanGer study demonstrated that the use of Impella CP reduces six-month mortality compared to standard treatment, although it is associated with an increased percentage of complications. The aim of this study is to evaluate the efficacy and safety of Impella CP in 'DanGer prototype' patients at our center.

Retrospective unicentric analysis of patients who met the inclusion criteria (STEMI complicated by CS and implantation of Impella CP) and exclusion criteria of the DanGer study (cardiac arrest with Glasgow score < 8, right ventricular infarction, and mechanical complications) between August 2020 and April 2024. The baseline characteristics and evolution of the sample were compared with the group of patients randomized to Impella CP in that trial (Table 1).

Out of a total of 28 patients who underwent femoral implantation of Impella CP, 8 patients were analyzed as DanGer type. Most patients were in SCAI stage D (4, 50%), with lower mean arterial pressure values (56 vs. 63 mmHg, p < 0.03) and higher arterial lactate levels (5.1 vs. 4.6 mmol/l, p < 0.01) compared to that trial. Additionally, the proportion of intubated patients was significantly higher [6 (75%) vs. 35 (16.9%), p < 0.001]. The timing of implantation varied significantly between the groups, with a greater tendency in our center for post-revascularization implantation. Mortality and morbidity (access bleeding and renal replacement therapy) were similar between both groups (Figure 1).

At our center, Impella CP implantation via femoral access as support for cardiogenic shock secondary to STEMI is performed in patients in a more severe condition (SCAI D, lactate 5.1 mmol/l, intubation) than those in the DanGer study treated with Impella. Despite this, clinical outcomes were similar. This may suggest that in patients with earlier stages of cardiogenic shock secondary to STEMI, prognosis could be improved.

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