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Heart Pump Before Stenting Shows No Benefit in STEMI Without Shock

Findings point clinicians away from routine use of Impella in this setting due to extra bleeding risk.

Overview

  • The randomized DTU trial, presented Saturday at the ACC Scientific Sessions and published in JACC, found no significant reduction in heart damage when an Impella pump was placed before PCI.
  • The study enrolled 527 people with anterior STEMI at 55 emergency rooms in five countries and compared delayed stenting after pump insertion with immediate stenting.
  • Major bleeding and blood vessel problems occurred in 30.8% of patients who received the device, which exceeded the trial’s predefined safety goal.
  • Despite about a 47-minute longer time to reopen the blocked artery in the device group, infarct size did not increase, a result investigators say may reflect some protective effect.
  • Impella CP is FDA-approved and used for cardiogenic shock, and this Abiomed-funded trial now steers research toward pairing unloading with blood-pressure–lowering drugs or faster device removal.