Abstract Body (Do not enter title and authors here): Background:
Despite advances in ventricular support devices, increasing awareness and multiple national initiatives to improve survival, mortality from cardiogenic shock remains high. Previous observational studies have shown decreased mortality rates with intra-aortic balloon pump usage over Impella. Relationship between support device use and overall survival in patients with cardiogenic shock remains an area of further investigation.

Aims: Our objective was to examine the temporal trends in the mortality and ventricular support in patients with cardiogenic shock undergoing PCI in Northern New England from 2018-2023.

Methods: The NNE registry was queried to identify patients presenting for PCI who manifest cardiogenic shock between 2018 and 2023. Shock was defined by the NCDR definition including sustained hypotension requiring inopressor use. Demographics, procedural data, mortality and intraprocedural ventricular support device use was collected. Standard statistical methods were used to calculate outcomes and statistical significance.

Results: A total of 842 patients were identified who presented with shock. Overall, in-hospital mortality was 30.9%, and varied from 27.72% in 2018 to 38.3% in 2021 during the height of the COVID-19 pandemic (Figure 1). Mechanical support use remained flat, with an average use of 56% of all cases (Figure 2). The distribution of intra-aortic balloon pumps and Impella devices changed, with Impella use increasing from around 41% in 2018 to 44% by the end of the study in 2023, and intra-aortic balloon pump usage declining from 55% in 2018 to 49% by 2023 (Figure 3). Data was limited to perform a correlation analysis between type of mechanical support device and mortality rates.

Conclusions: Despite using ventricular support in nearly 60% of cases, in-hospital mortality for cardiogenic shock remains around 30%. Our data reveals a trend towards higher Impella usage with declining intra-aortic balloon pump usage, interestingly with no change in mortality. This warrants further research to better understand how to optimize care for patients presenting with cardiogenic shock.