Higher BMI was independently associated with increased 30-day all-cause mortality (HR 1.07 per BMI unit) in cardiogenic shock patients treated with Impella, especially ECPELLA.
Does higher BMI increase 30-day mortality in cardiogenic shock patients supported by Impella?
In patients with cardiogenic shock supported by Impella, higher BMI is independently associated with increased 30-day mortality, particularly in those receiving concurrent VA-ECMO (ECPELLA).
Absolute Event Rate: 0% vs 0%
Abstract Background Cardiogenic shock (CS) remains a life-threatening condition despite advances in management, including the use of Impella for mechanical circulatory support. However, the impact of body mass index (BMI) on CS outcomes remains controversial. While some studies suggest a protective effect of higher BMI, others report neutral or negative associations. Objective This study examines the association between BMI and prognosis in CS patients who received Impella support. Methods The UNLOADERS-PVAD registry is a multicenter observational study in Japan, incorporating data from three leading Impella centers. In this cohort, 501 patients received Impella support between April 2018 and December 2023. After excluding one patient due to missing BMI data, a total of 500 patients were divided into high and low BMI groups based on the median BMI of 23.5, with 250 patients in each group. Clinical characteristics, diagnosis, and prognostic scores, including APACHE II, SAPS II, and SAVE, as well as 30-day mortality, were compared between the high and low BMI groups. Additionally, patients were categorized into four quartile groups based on BMI to evaluate 30-day mortality trends. Results Among the study population, there were no significant differences between the two groups in sex, height, comorbidities, medical history, or prognostic scores. However, the high BMI group was significantly younger and more likely to receive venoarterial extracorporeal membrane oxygenation with Impella (ECPELLA) and received extracorporeal cardiopulmonary resuscitation (E-CPR). Furthermore, the high BMI group had a significantly higher prevalence of acute coronary syndrome (ACS) as the primary pathology, whereas heart failure was more common in the low BMI group. In terms of outcomes, the high BMI group had a significantly lower Impella weaning rate (69% vs. 82%; p 0.001) and higher all-cause mortality (44% vs. 26%; p 0.001), including both cardiogenic and non-cardiogenic causes. When divided into four quartile groups based on BMI, an increasing BMI was significantly associated with a higher 30-day mortality rate. This trend was particularly significant among patients treated with ECPELLA. In the multivariable Cox analysis, which included age, BMI, ACS, E-CPR, ECPELLA, and prognostic scores, ECPELLA (hazard ratio HR: 2.86, 95% confidence interval CI: 1.76–4.69; p 0.001), the SAVE score (HR: 0.95, 95% CI: 0.92–0.99; p = 0.007), and BMI (HR: 1.07, 95% CI: 1.04–1.11; p 0.001) were identified as independent predictors of 30-day all-cause mortality. Conclusion In cardiogenic shock patients treated with Impella, a higher BMI was independently associated with increased 30-day mortality, particularly in those receiving ECPELLA.
Nakano et al. (Sat,) reported a other. Higher BMI was independently associated with increased 30-day all-cause mortality (HR 1.07 per BMI unit) in cardiogenic shock patients treated with Impella, especially ECPELLA.