ArticleJournal of the Society for Cardiovascular Angiography & Interventions2026
National Trends in Impella Utilization for Older Adult Patients With ST-Elevation Myocardial Infarction Complicated by Cardiogenic Shock.
Article in Journal of the Society for Cardiovascular Angiography & Interventions, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
Background: Current guidelines recommend implantation of a microaxial flow pump (mAFP) for selected patients with ST-elevation myocardial infarction (STEMI) complicated by cardiogenic shock (STEMI-CS). Although the DanGer Shock trial showed a mortality benefit with mAFP, a secondary analysis suggested that older adult patients may not experience the same benefit. This study evaluated the temporal trends in mAFP utilization and hospital mortality in older (≥75 years) vs younger STEMI-CS patients. Methods: Using the International Classification of Diseases, 10th Revision (ICD-10-CM) procedure codes from 344 hospitals with continuous data between 2016 and 2024 from the Vizient Clinical Data Base, we identified 20,692 patients undergoing percutaneous coronary intervention (PCI) for STEMI-CS. Temporal trends in mAFP use and mortality were stratified by older (≥75 years) vs younger age groups. Multivariable logistic regressions identified the predictors of hospital mortality. Results: Among 20,692 STEMI-CS patients undergoing PCI, 25% were ≥75 years. Older age was the strongest independent predictor of hospital mortality for STEMI-CS patients (odds ratio, 1.87; 95% CI, 1.75-2.00). Between 2016 and 2024, mAFP use for STEMI-CS increased from 9.3% to 21.5% in patients ≥75 years old and from 14% to 25.6% in patients <75 years old ( Conclusions: Approximately 1 in 5 older STEMI-CS patients received mAFP, with use more than doubling since 2016. Although mortality declined significantly in mAFP-treated younger STEMI-CS PCI patients, mortality in the older group remained approximately 60% higher than that of younger patients at all time points.
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