Combined Risk Stratification With Patient Characteristics and Biomarkers in Patients Treated With the Impella for Cardiogenic Shock
Background In patients with cardiogenic shock (CS), a percutaneous microaxial ventricular assist device (Impella, Abiomed, Danvers, MA) is a choice for temporary mechanical circulatory support. Given the high morbidity and mortality in this patient population, early risk stratification is relevant w...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2025-05-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.040487 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850270981623382016 |
|---|---|
| author | Yuichi Saito Yuki Shiko Kazuya Tateishi Koichi Toda Goro Matsumiya Yoshio Kobayashi |
| author_facet | Yuichi Saito Yuki Shiko Kazuya Tateishi Koichi Toda Goro Matsumiya Yoshio Kobayashi |
| author_sort | Yuichi Saito |
| collection | DOAJ |
| description | Background In patients with cardiogenic shock (CS), a percutaneous microaxial ventricular assist device (Impella, Abiomed, Danvers, MA) is a choice for temporary mechanical circulatory support. Given the high morbidity and mortality in this patient population, early risk stratification is relevant when making treatment decisions. Methods Using nationwide registry data between February 2020 and December 2022 in Japan, we included a total of 4122 patients with cardiogenic shock treated with the Impella devices. Using logistic regression analysis, we incorporated patient characteristics and biomarkers to develop a risk‐stratifying model for in‐hospital mortality. The model was also tested if applicable to composite outcomes of in‐hospital death and major complications. Results Of the 4122 patients with cardiogenic shock, the Impella was indicated for acute myocardial infarction in 2575 (62.5%). Multivariable analysis identified 4 patient characteristics (age, body mass index, out‐of‐hospital cardiac arrest, and blood pressure) and 6 biomarkers (lactate, lactate dehydrogenase, creatinine, total bilirubin, albumin, and creatinine kinase) with cutoff values as factors significantly associated with in‐hospital mortality. We developed a risk‐stratifying model using the 10 variables, which was predictive of in‐hospital death (area under the curve, 0.711; P<0.001). Adding biomarkers to patient characteristics significantly improved the diagnostic accuracy (area under the curve, from 0.649 to 0.711; P<0.001). This risk score was also predictive of death and major complications (area under the curve, 0.680; P<0.001). Conclusions In patients with cardiogenic shock treated with the Impella devices, our risk‐stratifying system, consisting of 4 patient characteristics and 6 biomarkers, strongly correlated with in‐hospital mortality, potentially facilitating clinical decision‐making. |
| format | Article |
| id | doaj-art-a8d8850f7eb64f69b7117d9dd6209013 |
| institution | OA Journals |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-a8d8850f7eb64f69b7117d9dd62090132025-08-20T01:52:22ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-05-0114910.1161/JAHA.124.040487Combined Risk Stratification With Patient Characteristics and Biomarkers in Patients Treated With the Impella for Cardiogenic ShockYuichi Saito0Yuki Shiko1Kazuya Tateishi2Koichi Toda3Goro Matsumiya4Yoshio Kobayashi5Department of Cardiovascular Medicine Chiba University Graduate School of Medicine Chiba JapanBiostatistics Section, Clinical Research Center Chiba University Hospital Chiba JapanDepartment of Cardiovascular Medicine Chiba University Graduate School of Medicine Chiba JapanDepartment of Cardiovascular Surgery Dokkyo Medical University Saitama Medical Center Koshigaya JapanDepartment of Cardiovascular Surgery Chiba University Graduate School of Medicine Chiba JapanDepartment of Cardiovascular Medicine Chiba University Graduate School of Medicine Chiba JapanBackground In patients with cardiogenic shock (CS), a percutaneous microaxial ventricular assist device (Impella, Abiomed, Danvers, MA) is a choice for temporary mechanical circulatory support. Given the high morbidity and mortality in this patient population, early risk stratification is relevant when making treatment decisions. Methods Using nationwide registry data between February 2020 and December 2022 in Japan, we included a total of 4122 patients with cardiogenic shock treated with the Impella devices. Using logistic regression analysis, we incorporated patient characteristics and biomarkers to develop a risk‐stratifying model for in‐hospital mortality. The model was also tested if applicable to composite outcomes of in‐hospital death and major complications. Results Of the 4122 patients with cardiogenic shock, the Impella was indicated for acute myocardial infarction in 2575 (62.5%). Multivariable analysis identified 4 patient characteristics (age, body mass index, out‐of‐hospital cardiac arrest, and blood pressure) and 6 biomarkers (lactate, lactate dehydrogenase, creatinine, total bilirubin, albumin, and creatinine kinase) with cutoff values as factors significantly associated with in‐hospital mortality. We developed a risk‐stratifying model using the 10 variables, which was predictive of in‐hospital death (area under the curve, 0.711; P<0.001). Adding biomarkers to patient characteristics significantly improved the diagnostic accuracy (area under the curve, from 0.649 to 0.711; P<0.001). This risk score was also predictive of death and major complications (area under the curve, 0.680; P<0.001). Conclusions In patients with cardiogenic shock treated with the Impella devices, our risk‐stratifying system, consisting of 4 patient characteristics and 6 biomarkers, strongly correlated with in‐hospital mortality, potentially facilitating clinical decision‐making.https://www.ahajournals.org/doi/10.1161/JAHA.124.040487cardiogenic shockImpellamechanical circulatory supportrisk stratification |
| spellingShingle | Yuichi Saito Yuki Shiko Kazuya Tateishi Koichi Toda Goro Matsumiya Yoshio Kobayashi Combined Risk Stratification With Patient Characteristics and Biomarkers in Patients Treated With the Impella for Cardiogenic Shock Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cardiogenic shock Impella mechanical circulatory support risk stratification |
| title | Combined Risk Stratification With Patient Characteristics and Biomarkers in Patients Treated With the Impella for Cardiogenic Shock |
| title_full | Combined Risk Stratification With Patient Characteristics and Biomarkers in Patients Treated With the Impella for Cardiogenic Shock |
| title_fullStr | Combined Risk Stratification With Patient Characteristics and Biomarkers in Patients Treated With the Impella for Cardiogenic Shock |
| title_full_unstemmed | Combined Risk Stratification With Patient Characteristics and Biomarkers in Patients Treated With the Impella for Cardiogenic Shock |
| title_short | Combined Risk Stratification With Patient Characteristics and Biomarkers in Patients Treated With the Impella for Cardiogenic Shock |
| title_sort | combined risk stratification with patient characteristics and biomarkers in patients treated with the impella for cardiogenic shock |
| topic | cardiogenic shock Impella mechanical circulatory support risk stratification |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.040487 |
| work_keys_str_mv | AT yuichisaito combinedriskstratificationwithpatientcharacteristicsandbiomarkersinpatientstreatedwiththeimpellaforcardiogenicshock AT yukishiko combinedriskstratificationwithpatientcharacteristicsandbiomarkersinpatientstreatedwiththeimpellaforcardiogenicshock AT kazuyatateishi combinedriskstratificationwithpatientcharacteristicsandbiomarkersinpatientstreatedwiththeimpellaforcardiogenicshock AT koichitoda combinedriskstratificationwithpatientcharacteristicsandbiomarkersinpatientstreatedwiththeimpellaforcardiogenicshock AT goromatsumiya combinedriskstratificationwithpatientcharacteristicsandbiomarkersinpatientstreatedwiththeimpellaforcardiogenicshock AT yoshiokobayashi combinedriskstratificationwithpatientcharacteristicsandbiomarkersinpatientstreatedwiththeimpellaforcardiogenicshock |