Timing of Impella Implantation After ECMO in Acute Myocardial Infarction Complicated by Cardiogenic Shock

Document Type

Conference Proceeding

Publication Date

4-7-2026

Publication Title

Journal of the American College of Cardiology

Abstract

BACKGROUND Extracorporeal membrane oxygenation (ECMO) can stabilize hemodynamics in acute myocardial infarction complicated by cardiogenic shock (AMI-CS). Impella for left ventricular venting may improve myocardial recovery, but optimal Impella implantation timing remains unknown. METHODS Using the TriNetX Research Network, we identified 1273 patients with AMI-CS supported with ECMO between 2015 and 2025. Propensity score matching to study Impella timing after ECMO yielded 242 pairs for same-day vs. 1 day, 185 pairs for same-day vs. 2 days, 151 pairs for same-day vs. 3 days, 181 pairs for 1 vs. 2 days, 150 pairs for 1 vs. 3 days, and 149 pairs for 2 vs. 3 days. Cox proportional hazard models estimated hazard ratios (HRs) with 95% confidence intervals (CIs). RESULTS At 1 month, same-day Impella implantation was associated with a higher incidence of acute kidney injury compared with day 2 (HR 1.44; 95% CI 1.07-1.94) or day 3 implantation (HR 1.41; 95% CI 1.02-1.96). At 6 months and 1 year, same-day implantation was associated with a higher risk of all-cause hospitalization compared with day 2 implantation (HR 1.35; 95% CI 1.01-1.82) and (HR 1.34; 95% CI 1.02-1.80), respectively. No significant differences were observed in all-cause mortality (Figure), stroke, or peripheral limb ischemia. CONCLUSION In patients with AMI-CS on ECMO, Impella implantation anytime within the first 3 days was not associated with significant differences in long-term mortality or major

Volume

87

Issue

13 Suppl

First Page

A680

Comments

American College of Cardiology 75th Annual Scientific Session & Expo, March 28-30, 2026, New Orleans, LA

Last Page

A680

DOI

10.1016/j.jacc.2026.02.1782

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