The Impact of Age in Patients Undergoing Impella-Assisted Percutaneous Coronary Interventions.

BACKGROUND: Short-term percutaneous mechanical circulatory support (MCS) devices provide hemodynamic support in cardiogenic shock or during high-risk percutaneous coronary intervention (PCI).

AIMS: To assess the impact of age on the clinical and angiographic characteristics and in-hospital outcomes of all patients undergoing PCI with the Impella MCS.

METHODS: Data on all patients that underwent PCI with an Impella was divided into three groups according to age: < 65, 65 to < 75 years, and ≥ 75 years. In-hospital mortality, stroke, and major bleeding complications were assessed.

RESULTS: Between 2010 and 2018, 245 patients underwent PCI with Impella support. Almost half of all patients were < 65 years old and 32% were ≥ 75 year old. Clinical characteristics varied significantly among the three groups. Almost half of younger patients were in the midst of an ST-elevation myocardial infarction (STEMI) compared with 9% of patients ≥ 75 years (p < 0.0001). Furthermore, 57% of younger patients were in cardiogenic shock, compared with 21% of those ≥ 75 years (p = 0.002). In-hospital mortality was highest in the 65 to < 75 years group (17%) compared with 9% and 10% in the < 65 and ≥ 75-year-olds groups, respectively. Major bleeding complications were not significantly different among the three age groups. Multivariable analysis for in-hospital mortality showed that STEMI on presentation and ages 65 to < 75 years compared to those < 65 years were associated with an increased odds of in-hospital death.

CONCLUSION: Clinical characteristics and indications for Impella MCS use in patients undergoing PCI varied significantly according to age. However, in-hospital outcomes were not significantly different among the three groups.