The new Impella clinical data is detailed in this chart was presented at an October 2019 meeting in Detroit for the management of patients in cardiogenic shock, led by the National Cardiogenic Shock Initiative (NCSI) Study principal investigators.
October 28, 2019 — Nearly two years of real-world outcomes data on Abiomed’s Impella RP heart pump shows that when physicians followed the U.S. Food and Drug Administration (FDA) approved protocol for Impella RP use, they achieved 72 percent patient survival and 88 percent native heart recovery. These results, from the Impella RP’s post-approval study, match the survival rate in the Impella RP’s pre-market approval (PMA) study. The protocol includes recommendations on patient selection and timely identification of right heart failure with subsequent implantation of Impella RP.
The new data is detailed in the accompanying chart and was presented in October at a clinical meeting in Detroit for the management of patients in cardiogenic shock, led by the National Cardiogenic Shock Initiative (NCSI) Study principal investigators.
“When right-sided heart failure is identified early, it is reversible and heart recovery is possible,” said Navin Kapur, M.D., the executive director of the CardioVascular Center for Research and Innovation (CVCRI) at Tufts Medical Center and principal investigator for the Cardiogenic Shock Working Group (CSWG). “Elevated RA (right atrial) pressure in a patient with cardiogenic shock is a warning sign that a patient is at an increased risk of dying and should trigger a comprehensive evaluation for underlying causes including right heart failure. If right heart dysfunction is identified, therapy should be escalated to manage this issue as soon as possible.”
Investigators and thought leaders in the field of cardiogenic shock have made multiple recommendations based on data sets which demonstrate late identification of right heart failure is associated with increased mortality:
• The Cardiogenic Shock Working Group found cardiogenic shock patients with elevated right arterial pressure (RAP) are at a higher risk of mortality and should be evaluated for RV failure as soon as possible;
• The National Cardiogenic Shock Initiative Study includes the following escalation protocol: After Impella-supported PCI, and while the patient is in the catherization lab, if the patient is in right ventricular (RV) failure, quickly escalate to Impella RP; and
• The cVAD Study has demonstrated patients with a left-side Impella who have a RAP or central venous pressure (CVP) of 12 mmHg or above are at higher risk of mortality (p=0.035), and rapid assessment for RV failure is recommended.
“We are pleased to see the numerical increase in survival for both the Recover Right and salvage populations in the Impella RP post approval study. The FDA’s letters to health care providers earlier this year have helped Abiomed and the post-approval study principal investigators educate other medical providers on the importance of using simple identifiers to achieve timely identification of right side heart failure in the catheterization lab and ICU,” said Seth Bilazarian, M.D., the chief medical officer of Abiomed.
The FDA has confirmed the classification of Impella RP post-approval study patients into two categories: Recover Right protocol and salvage support. The Recover Right category includes patients who met the inclusion and exclusion criteria of the Recover Right FDA PMA clinical trial for Impella RP. The FDA recognizes salvage patients as those outside the Recover Right protocol (including more than 48 hours in cardiogenic shock from right side failure.) The baseline characteristics of the two populations are different with higher mortality in the salvage group. Salvage patients are some of the sickest patients in the hospital and many have suffered out-of-hospital cardiac arrest or may have been transferred to multiple hospitals before receiving Impella RP. The FDA and Abiomed believe that physicians should have the ability to attempt lifesaving recovery measures on these salvage patients based on their best judgement but emphasize that earlier recognition and treatment is associated with markedly better survival.
In a letter to healthcare providers on May 21, the FDA noted the importance of proper patient selection and timing of Impella RP insertion. The FDA wrote, “Patients who would not have qualified for the pre-market clinical studies were more likely to have been in cardiogenic shock for longer than 48 hours, experienced a cardiac arrest, or suffered a pre-implant hypoxic or ischemic neurologic event before getting the Impella RP system implanted compared to the PAS patients who would have met the enrollment criteria for the premarket clinical studies.”
The FDA also wrote, “Additionally, be aware that there are currently no other device interventions that have been approved by the FDA under the premarket application (PMA) process for the patient population demonstrating a higher mortality rate in the PAS. As such, other interventions may include their own benefits and risks that should be considered and discussed with patients and their caregivers.”
Abiomed is committed to improving patient outcomes by performing FDA studies and post-market surveillance, collecting real-world evidence, and identifying and sharing best practices. Abiomed tracks outcomes on nearly 100 percent of its U.S. patients through its Impella Quality (IQ) Database, helps improve patient outcomes by providing 24x7 on call and on-site support and prospectively conducts FDA post-approval studies through the IRB-approved cVAD Study.
For more information: www.impella.com
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