| アブストラクト | BACKGROUND: Optimal unloading strategies for patients with cardiogenic shock requiring venoarterial extracorporeal membrane oxygenation remain uncertain, particularly when comparing Impella and intra-aortic balloon pump (IABP). We aimed to compare outcomes of patients receiving Impella or IABP during venoarterial extracorporeal membrane oxygenation and evaluate cause-specific differences. METHODS: In this retrospective cohort study using the nationwide JROAD-DPC (Japanese Registry of All Cardiac and Vascular Diseases-Diagnosis Procedure Combination) database from 2012 to 2023, patients with cardiogenic shock treated with venoarterial extracorporeal membrane oxygenation and either Impella or IABP were analyzed. Propensity score-based inverse probability of treatment weighting was applied to adjust baseline differences. RESULTS: Among 18 906 patients (Impella, n=1688; IABP, n=17 218), overall in-hospital mortality was 57.3% with Impella and 67.2% with IABP. Impella use was associated with lower in-hospital mortality compared with IABP (odds ratio [OR], 0.86 [95% CI, 0.75-0.99]). Cause-specific analyses showed significantly lower mortality with Impella in heart failure (OR, 0.66 [95% CI, 0.47-0.91]) and arrhythmia (OR, 0.62 [95% CI, 0.42-0.91]). Impella use was also associated with longer hospital stay (median, 22 versus 12 days), longer support duration (7 versus 4 days), and higher total costs (56.1 versus 27.3 thousand USD). CONCLUSIONS: In this nationwide cohort, Impella unloading during venoarterial extracorporeal membrane oxygenation was associated with lower in-hospital mortality than IABP in the overall cohort, particularly in selected causes, at the expense of prolonged hospitalization and higher costs. Further studies are needed to define optimal cause-specific unloading strategies in cardiogenic shock. |
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| ジャーナル名 | Journal of the American Heart Association |
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| Pubmed追加日 | 2026/7/31 |
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| 投稿者 | Ito, Ryota; Kondo, Toru; Kazama, Shingo; Araki, Takashi; Imaizumi, Takahiro; Nabeta, Takeru; Ikeda, Yuki; Matsuzoe, Hiroki; Matsumura, Koichiro; Kanaoka, Koshiro; Nagai, Toshiyuki; Fujino, Takeo; Morimoto, Ryota; Murohara, Toyoaki |
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| 組織名 | Department of Cardiology Nagoya University Graduate School of Medicine Nagoya;Japan.;Department of Cardiology JA Aichi Koseiren Kainan Hospital Yatomi Japan.;Department of Advanced Medicine Nagoya University Hospital Nagoya Japan.;Department of Clinical Research Education Nagoya University Graduate School of;Medicine Nagoya Japan.;Department of Cardiovascular Medicine Kitasato University School of Medicine;Sagamihara Japan.;Department of Cardiology Kindai University Faculty of Medicine Sakai Japan.;Department of Medical and Health Information Management National Cerebral and;Cardiovascular Center Suita Japan.;Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of;Medicine Hokkaido University Sapporo Japan.;Department of Advanced Cardiopulmonary Failure, Graduate School of Medical;Sciences Kyushu University Fukuoka Japan. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/42535545/ |
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