Log in to MyACC
Intravascular LVAD vs. IABP in AMI With Shock
Quick Takes
- The current retrospective analysis compared short- and long-term clinical outcomes among patients with acute MI with cardiogenic shock who received either IABP or intravascular LVAD therapy.
- Intravascular LVAD is associated with increased risk of mortality, bleeding, need for kidney replacement therapy, and cost both during the hospitalization and up to 1 year after discharge compared to IABP.
Study Questions:
What is the association between intravascular left ventricular assist device (LVAD) or intra-aortic balloon pump (IABP) use and clinical outcomes and cost in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS)?
Methods:
This retrospective propensity-matched cohort study used administrative claims data for commercially insured patients from 14 states across the United States. Patients included in the analysis underwent PCI for AMI complicated by CS from January 1, 2015–April 30, 2020. Data analysis was performed from April–November 2021. The primary outcomes were mortality, stroke, severe bleeding, repeat revascularization, kidney replacement therapy (KRT), and total health care costs during the index admission. Clinical outcomes and cost were also assessed at 30 days and 1 year.
Results:
Among 3,077 patients undergoing PCI for AMI complicated by CS, the mean (standard deviation) age was 65.2 (12.5) years, and 986 (32.0%) had cardiac arrest. Among 817 propensity-matched pairs, intravascular LVAD use was associated with significantly higher in-hospital (36.2% vs. 25.8%; odds ratio [OR], 1.63; 95% confidence interval [CI], 1.32-2.02), 30-day (40.1% vs. 28.3%; OR, 1.71; 95% CI, 1.37-2.13), and 1-year mortality (58.9% vs. 45.0%; hazard ratio [HR], 1.44; 95% CI, 1.21-1.71) compared with IABP. At 30 days, intravascular LVAD use was associated with significantly higher bleeding (19.1% vs. 14.5%; OR, 1.35; 95% CI, 1.04-1.76), KRT (12.2% vs. 7.0%; OR, 1.88; 95% CI, 1.30-2.73), and mean cost (+$51,680; 95% CI, $31,488-$75,178). At 1 year, the association of intravascular LVAD use with bleeding (29.7% vs. 24.3%; HR, 1.36; 95% CI, 1.05-1.75), KRT (18.1% vs. 10.9%; HR, 1.95; 95% CI, 1.35-2.83), and mean cost (+$46,609; 95% CI, $22,126-$75,461) persisted.
Conclusions:
In this propensity-matched analysis of patients undergoing PCI for AMI complicated by CS, intravascular LVAD use was associated with increased short-term and 1-year risk of mortality, bleeding, KRT, and cost compared with IABP. There is an urgent need for additional evidence surrounding the optimal management of patients with AMI complicated by CS.
Perspective:
The current retrospective analysis compared short- and long-term clinical outcomes among patients with AMI with CS who received either IABP or intravascular LVAD therapy. Findings show increased risk of mortality, bleeding, need for KRT, and cost both during the hospitalization and up to 1 year after discharge among patients receiving intravascular LVAD. Barring impact of residual confounding and persistent selection bias, findings challenge the reported benefits of LVAD over IABP among patients with AMI and shock.
Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Cardiac Surgery, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Acute Heart Failure, Mechanical Circulatory Support, Interventions and ACS
Keywords: Acute Coronary Syndrome, Health Care Costs, Heart Arrest, Heart Failure, Heart-Assist Devices, Hemorrhage, Intra-Aortic Balloon Pumping, Myocardial Infarction, Myocardial Ischemia, Myocardial Revascularization, Outcome Assessment, Health Care, Patient Discharge, Percutaneous Coronary Intervention, Renal Replacement Therapy, Secondary Prevention, Shock, Cardiogenic, Stroke
< Back to Listings
