Beforethe launch of Impella, the 30-day mortality rate for patients with cardiogenicshock in acute coronary syndrome (ACS-CS) was reported tobe  approximately 40-50%. In the J-PVAD registry, the 30-daysurvival rate was 80.9 % for Impella alone and 45.7 % for Impella withextracorporeal membrane oxygenation (ECMO). Data onthe interaction between the introduction of mechanical circulatory support (MCS)before Cardiopulmonary arrest (CPA) and early clinical outcome are limited. 

This study aimed to compare the 30-day survival rate in ACS patientswith Cardiogenic shock (CS) required ECPELLA vs. Impella alone.Retrospective, single center, observationalstudyPeriod: between June 2019 and December2022Object: ACS-CS cases with primary PCI whowere introduced IMPELLA or ECPELLAOutcome: 30-day survival rates

From June 2019 to December 2022, weperformed 697 emergent PCI for ACS and introduced 41 Impella (5.8%) at ourhospital. The ECPELLA group included 13 cases (31.7%, 12 males, mean age of 69 ± 11 years, 9 STEMI cases) and the remaining 28 cases (68.3%, 23males, mean age of 69 ± 11years, 21 STEMI cases) were included in the Impella alone group, respectively. CPAwas seen in 8 patients in the ECPELLA group and in 4 patients in the Impellaalone group. Overall, 30-day survival rate was significantly lower in ECPELLAcompared with Impella alone (ECPELLA vs. Impella alone: 5 / 13 cases, 38.5% vs21 / 28 cases, 75.0%, p = 0.0376 ). Whereas, for CS patients with non-CPA, therewas no significant difference in the 30-day survival rates between the 2 groups(ECPELLA: 4 / 5 cases, 80% vs. Impella alone: 18 / 24 cases, 75.0 %, p > 0.99). 

This wasretrospective, small size and single center study.  A larger sample size may lead to changesin survival rates and complication rates.In our current experience, non-CPA in patientswith ECPELLA compared to those with Impella alone had similar 30-day survivalrates.