Impella use fails to improve mortality in elderly patients
The landmark DANGER SHOCK trial showed that using an Impella CP heart pump when treating cardiogenic shock improved outcomes. However, the one exception was patients 77 years old and older. A recent study tracked real-world registry and outcomes data on these older patients to see if the trend was evident there as well. The full analysis is available from JSCAI.[1]
Andres Cordova, MD, a cardiology fellow with University of Vermont Medical Center, presented the data at TCT 2025. He spoke to Cardiovascular Business about his team's findings.
"It was interesting to note there was a significant increase in the use of Impella between 2016 to 2024. In younger patients, Impella is decreasing mortality, but in the elderly population, there was no statistical significance," Cordova explained. "Overall, elderly patients had a 60% higher mortality rate than younger patients at any time point."
The study reviewed data from ICD-10 procedure codes from 344 hospitals with continuous data between 2016 and 2024 from the Vizient Clinical Data Base. The researchers found 20,692 patients who underwent percutaneous coronary intervention (PCI) for STEMI cardiogenic shock (STEMI-CS). They looked at temporal trends in Impella mechanical circulatory support use and mortality rates stratified by patients ages 75 and older versus younger age groups.
Among patients in this study cohort, 25% were 75 years old or older. Cordova said older age was the strongest independent predictor of hospital mortality for STEMI-CS.
Between 2016 and 2024, Impella use for STEMI-CS increased from 9.3% to 21.5% in patients 75 and older, and from 14% to 25.6% in patients younger than 75. Mortality declined in younger patients from 45% in 2016 to 38% in 2024. The mortality rate for older PCI patients with STEMI-CS and Impella utilization was consistently above 50%.
The new data suggest there is a need for additional studies to evaluate the best treatment strategy for elderly patients. He said this may include comparing Impella to intra-aortic balloon pump to see if there is any noticeable difference in outcomes. Additionally, Cordova said any new cardiogenic shock trials with Impella should take into account the frailty and comorbidities of elderly patients to try and look at ways to reducing mortality in this population.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]