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STEMI Door-to-Unload Impella trial skepticism

March 28, 2026C. Michael Gibson MD, Dr Shariq Shamim, Dr. Purvi Parwani

C. Michael Gibson, Dr Shariq Shamim, Dr. Purvi Parwani, Davide Capodanno, and others highlight that delaying PCI to unload the LV with Impella did not reduce infarct size and increased bleeding or complications.

did not reduce infarct size vs. immediate PCI
failed to show the benefit for Impella
Impella support— ~6x more bleeding/vascular complications
putting a micro-axial flow pump 30 minutes before PCI in STEMIs without shock always struck me as more risky than beneficial
it quintuples BARC 3 bleeding
C. Michael Gibson MD
Dr Shariq Shamim
Dr. Purvi Parwani
Davide Capodanno
cardiologySTEMIACC26

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