# National Trends in Impella Utilization for Older Adult Patients With ST-Elevation Myocardial Infarction Complicated by Cardiogenic Shock

## TL;DR

This study examines how often a heart pump is used in older patients with a severe heart condition and finds that while use has increased, older patients still have higher mortality rates compared to younger ones.

## Contribution

The study provides new insights into the utilization trends and outcomes of mAFP in older STEMI-CS patients compared to younger patients.

## Key findings

- mAFP use increased from 9.3% to 21.5% in older patients and from 14% to 25.6% in younger patients between 2016 and 2024.
- Mortality in mAFP-treated younger patients declined significantly, but older patients had consistently higher mortality rates above 50%.

## Abstract

Current guidelines recommend implantation of a microaxial flow pump (mAFP) for selected patients with ST-elevation myocardial infarction (STEMI) complicated by cardiogenic shock (STEMI-CS). Although the DanGer Shock trial showed a mortality benefit with mAFP, a secondary analysis suggested that older adult patients may not experience the same benefit. This study evaluated the temporal trends in mAFP utilization and hospital mortality in older (≥75 years) vs younger STEMI-CS patients.

Using the International Classification of Diseases, 10th Revision (ICD-10-CM) procedure codes from 344 hospitals with continuous data between 2016 and 2024 from the Vizient Clinical Data Base, we identified 20,692 patients undergoing percutaneous coronary intervention (PCI) for STEMI-CS. Temporal trends in mAFP use and mortality were stratified by older (≥75 years) vs younger age groups. Multivariable logistic regressions identified the predictors of hospital mortality.

Among 20,692 STEMI-CS patients undergoing PCI, 25% were ≥75 years. Older age was the strongest independent predictor of hospital mortality for STEMI-CS patients (odds ratio, 1.87; 95% CI, 1.75-2.00). Between 2016 and 2024, mAFP use for STEMI-CS increased from 9.3% to 21.5% in patients ≥75 years old and from 14% to 25.6% in patients <75 years old (P value for trend = .05 and .02, respectively). Mortality declined in mAFP patients <75 years old (45% in 2016 vs 38% in 2024; P = .003). The mortality rate for older PCI patients with STEMI-CS and mAFP utilization was consistently above 50%.

Approximately 1 in 5 older STEMI-CS patients received mAFP, with use more than doubling since 2016. Although mortality declined significantly in mAFP-treated younger STEMI-CS PCI patients, mortality in the older group remained approximately 60% higher than that of younger patients at all time points.