To investigate the relationship between annual institutional volume of Impella procedures and in-hospital mortality in patients with cardiogenic shock.
Key Findings:
Overall in-hospital mortality was 43.5%, with lower mortality observed at higher volume institutions.
Patients at Q4 institutions had significantly lower in-hospital mortality (adjusted OR 0.67) and 30-day mortality (adjusted OR 0.69) compared to Q1 institutions.
An inverse, nonlinear association between annual institutional volume and in-hospital mortality was found, with significant reductions at approximately 24 cases per year.
Interpretation:
Higher annual institutional volume of Impella procedures is associated with improved patient outcomes, suggesting that consolidating procedures at experienced centers may enhance care for cardiogenic shock patients.
Limitations:
Observational design limits causal inference and may include unmeasured confounders.
Potential underreporting of complications at lower-volume centers.
Long-term outcomes were not assessed.
Findings may not generalize to other healthcare systems or later periods.
Conclusion:
A higher annual institutional volume is linked to lower in-hospital mortality in cardiogenic shock patients, supporting the consolidation of Impella use at experienced centers.
