Women With Cardiogenic Shock Derive Greater Benefit From Impella 2.5

June 3, 2016
The aim of this recent cVAD Registry analysis was to assess survival differences between men and women supported with Impella 2.5 in the setting of acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). The articleconcludes that early initiation of hemodynamic support prior to PCI with Impella 2.5, in the setting of AMI complicated by CS, was associated with a greater survival benefit to hospital discharge in women compared to men. This despite a higher predicted risk of mortality and a greater revascularization failure rate for women.

Cardiogenic Shock – Indication & Safety Info.

Indication for Use

The Impella 2.5™, Impella CP®, Impella 5.0™ and Impella LD™ catheters, in conjunction with the Automated Impella Controller, are temporary ventricular support devices intended for short term use (≤ 4 days for the Impella 2.5 and Impella CP, and ≤ 6 days for the Impella 5.0 and LD) and indicated for the treatment of ongoing cardiogenic shock that occurs immediately (< 48 hours) following acute myocardial infarction or open heart surgery as a result of isolated left ventricular failure that is not responsive to optimal medical management and conventional treatment measures.* The intent of the Impella system therapy is to reduce ventricular work and to provide the circulatory support necessary to allow heart recovery and early assessment of residual myocardial function.
* Optimal medical management and convention treatment measures include volume loading and use of pressors and inotropes, with or without IABP.

Contraindications

In connection with the above indications, the Impella devices are contraindicated for use in patients experiencing the following conditions:
Mural thrombus in the left ventricle; Presence of a mechanical aortic valve or heart constrictive device; Aortic valve stenosis/calcification (equivalent to an orifice area of 0.6 cm2 or less); Moderate to severe aortic insufficiency (echocardiographic assessment of aortic insufficiency graded as ≥ +2); Severe peripheral arterial disease that precludes the placement of the Impella System; Significant right heart failure; Combined cardiorespiratory failure; Presence of an Atrial or Ventricular Sepal Defect (including post-infarct VSD); Left ventricular rupture; and Cardiac tamponade.

Potential Adverse Events

Additionally, potential for the following risks has been found to exist with use of the Impella devices in the above indications: Acute renal dysfunction; Aortic insufficiency; Aortic valve injury; Atrial fibrillation; Bleeding; Cardiogenic shock; Cardiac tamponade; Cardiopulmonary resuscitation; Cerebral vascular accident/Stroke; Death; Device malfunction; Failure to achieve angiographic success; Hemolysis; Hepatic failure; Insertion site infection; Limb ischemia; Myocardial infarction; Need for cardiac, thoracic or abdominal operation; Perforation; Renal failure; Repeat revascularization; Respiratory dysfunction; Sepsis; Severe hypotension; Thrombocytopenia; Thrombotic vascular (non-CNS) complication; Transient ischemic attack; Vascular injury; Ventricular arrhythmia, fibrillation or tachycardia.

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