European heart journal. Acute cardiovascular care | 2021
Long-term 5-year outcome of the randomized IMPRESS in severe shock trial: percutaneous mechanical circulatory support vs. intra-aortic balloon pump in cardiogenic shock after acute myocardial infarction.
AIMS\nTo assess differences in long-term outcome and functional status of patients with cardiogenic shock (CS) treated by percutaneous mechanical circulatory support (pMCS) and intra-aortic balloon pump (IABP).\n\n\nMETHODS AND RESULTS\nLong-term follow-up of the multicentre, randomized IMPRESS in Severe Shock trial (NTR3450) was performed 5-year after initial randomization. Between 2012 and 2015, a total of 48 patients with severe CS from acute myocardial infarction (AMI) with ST-segment elevation undergoing immediate revascularization were randomized to pMCS by Impella CP (n\u2009=\u200924) or IABP (n\u2009=\u200924). For the 5-year assessment, all-cause mortality, functional status, and occurrence of major adverse cardiac and cerebrovascular event (MACCE) were assessed. MACCE consisted of death, myocardial re-infarction, repeat percutaneous coronary intervention, coronary artery bypass grafting, and stroke. Five-year mortality was 50% (n\u2009=\u200912/24) in pMCS patients and 63% (n\u2009=\u200915/24) in IABP patients (relative risk 0.87, 95% confidence interval 0.47-1.59, P\u2009=\u20090.65). MACCE occurred in 12/24 (50%) of the pMCS patients vs. 19/24 (79%) of the IABP patients (P\u2009=\u20090.07). All survivors except for one were in New York Heart Association Class I/II [pMCS n\u2009=\u200910 (91%) and IABP n\u2009=\u20097 (100%), P\u2009=\u20091.00] and none of the patients had residual angina. There were no differences in left ventricular ejection fraction between the groups (pMCS 52\u2009±\u200911% vs. IABP 48\u2009±\u200910%, P\u2009=\u20090.53).\n\n\nCONCLUSIONS\nIn this explorative randomized trial of patients with severe CS after AMI, there was no difference in long-term 5-year mortality between pMCS and IABP-treated patients, supporting previously published short-term data and in accordance with other long-term CS trials.