Multicenter registry of Impella-assisted high-risk percutaneous coronary interventions and cardiogenic shock in Poland (IMPELLA-PL).

BACKGROUND: Impella is a percutaneous mechanical circulatory support device for treatment of cardiogenic shock (CS) and high-risk percutaneous coronary interventions (HR-PCIs). IMPELLA-PL is a national retrospective registry of Impella-treated CS and HR-PCI patients in 20 Polish interventional cardiological centers, conducted from January 2014 until December 2021. AIMS: We aimed to determine the efficacy and safety of Impella using real-world data from IMPELLA-PL and compare these with other registries. METHODS: IMPELLA-PL data were analyzed to determine primary endpoints: in-hospital mortality and rates of mortality and major adverse cardiovascular and cerebrovascular events (MACCE) at 12 months post-discharge. RESULTS: Of 308 patients, 18% had CS and 82% underwent HR-PCI. In-hospital mortality rates were 76.4% and 8.3% in the CS and HR-PCI groups, respectively. The 12-month mortality rates were 80.0% and 18.2%, and post-discharge MACCE rates were 9.1% and 22.5%, respectively. Any access site bleeding occurred in 30.9% of CS patients and 14.6% of HR-PCI patients, limb ischemia in 12.7% and 2.4%, and hemolysis in 10.9% and 1.6%, respectively. CONCLUSIONS: Impella is safe and effective during HR-PCIs, in accordance with previous registry analyses. The risk profile and mortality in CS patients were higher than in other registries, and the potential benefits of Impella in CS require investigation.

Clinical presentation and pharmacological therapy in patients with cardiogenic pulmonary oedema.

BACKGROUND: Cardiogenic pulmonary oedema is a typical clinical presentation of acute heart failure and is associated with a poor outcome. Therapeutic strategies in patients with this condition have not yet been uniformly developed and are based on expert consensus rather than results of randomised studies. The underlying aetiology seems to be one of the most important factors influencing therapy. AIM: To evaluate treatment of patients with acute cardiogenic pulmonary oedema. METHODS: The analysed group consisted of 276 consecutive patients who were treated due to acute cardiogenic pulmonary oedema in two cardiac centres in the city of Lódz between 1998 and 2000. Clinical characteristics, aetiology and therapy were retrospectively analysed based on medical records. RESULTS: Fifty nine (21%) patients died in hospital whereas the remaining 218 subjects were discharged. Etiologic Results. Fifty nine (21%) patients died in hospital whereas the remaining 218 subjects were discharged. Etiologic factors included a marked elevation of blood pressure (BP) (29%), acute myocardial infarction (MI) (25%), unstable angina (16%), decompensation of valvular disorder (9%), respiratory tract infection (8%) and paroxysmal atrial fibrillation (4%). The highest in-hospital mortality (35%) was associated with acute MI, and the lowest (6%) - with BP elevation. The most frequently used agents during in-hospital stay were diuretics (89%), followed by antibiotics (84%) and acetylsalicylic acid (81%). Compared with survivors, patients who died during hospital stay were significantly more frequently treated with catecholamines (59% vs 7%, p<0.00001), corticosteroids (71% vs 15%, p<0.00001) and morphine (62% vs 41%, p<0.0015) whereas angiotensin converting enzyme inhibitors, intravenous nitroglycerine, beta-blockers and acetylsalicylic acid were less frequently used in deceased patients (34% vs 89%, p<0.00001; 52% vs 78%, p<0.00001; 14% vs 37%, p<0.001; and 64% vs 86%, p<0.0003, respectively). CONCLUSIONS: In spite of intensive pharmacotherapy, cardiogenic pulmonary oedema is still associated with a high in-hospital mortality. Therapy should be tailored according to aetiology. Differences in pharmacological treatment between survivors and deceased patients depict better prognosis in those who have on admission normal or elevated blood pressure which enables an early administration of vasodilators and beta-blockers.

Pulmonary edema prognostic score predicts in-hospital mortality risk in patients with acute cardiogenic pulmonary edema.

BACKGROUND: Congestive heart failure is a common cardiac disorder associated with a high mortality. There are a limited number of prognostic scales predicting in-hospital outcomes after an acute episode of congestive heart failure. OBJECTIVES: The goal of this investigation was to develop a simple prognostic score predicting in-hospital outcome in patients with acute cardiogenic pulmonary edema. METHODS: We retrospectively studied 276 consecutive patients hospitalized with acute pulmonary edema from the years 1998 to 2000. RESULTS: During the initial hospitalization, 58 patients (21%) died and 218 patients (79%) were discharged. Statistical analyses revealed that the most significant predictors of inhospital mortality were acute myocardial infarction, heart rate greater than 115/beats/min, systolic blood pressure of 130 mm Hg or less, and white blood cell count greater than 11,500/mm3 on presentation. The presence of each factor was scored as 1 point, and the absence was scored as 0 points. The Pulmonary Edema Prognostic Score (PEPS) was defined as a sum of all points. Patients with a PEPS of 0 had good short-term prognosis with a 2% in-hospital mortality rate, whereas mortality in patients with a PEPS of 4 was 64%. CONCLUSIONS: The PEPS is a simple tool that can be easily calculated using common clinical diagnostic tests (electrocardiogram, blood pressure, heart rate, and white cell count) to determine in-hospital mortality risk in patients with an acute episode of cardiogenic pulmonary edema.