Impella – a treatment for all STEMI patients with cardiogenic shock? The effect of off-hours admission

Prompt reperfusion is pivotal for improving prognosis in patients with ST-segment elevation myocardial infarction (STEMI)1. Thus, admission and revascularisation of patients with STEMI occur 24/7, owing to the unpredictable and acute nature of the disease. Yet, the time of admission may entail considerable significance for prognosis, a phenomenon called the off-hours effect2. The term refers to patients admitted at night or at weekends, and contemporary data suggest a worse prognosis for off-hours admissions compared to on-hours2. Intuitively, this tendency may be further accentuated in the most severe and acute STEMI cases, namely those in cardiogenic shock (CS).

CS is the most severe presentation of STEMI and bears a 50% mortality rate1. It is characterised by tissue hypoperfusion owing to myocardial ischaemia and subsequent left ventricular dysfunction. Consequently, the use of mechanical circulatory support (MCS) to ensure haemodynamic stability through the unloading of the left ventricle has been of great interest. Until recently, randomised trials evaluating various MCS devices have failed to show prognostic benefit in STEMI complicated by CS1. Yet, the newly published Danish Cardiogenic...