NCDR Study Shows Increased Use of Intravascular Microaxial LVADs, Corresponding Decreased Use of IABPs

Use of intravascular microaxial left ventricular assist devices (LVADs) increased between 2015 and 2017, corresponding with decreased use of intra-aortic balloon pumps (IABPs), in patients undergoing PCI for acute myocardial infarction (AMI) complicated by cardiogenic shock, according to a study published Feb. 22 in JAMA Network Open.

Sanket S. Dhruva, MD, MHS, FACC, et al., used data from ACC's Chest Pain – MI Registry and CathPCI Registry to identify all patients who underwent PCI for AMI complicated by cardiogenic shock between October 2015 and December 2017. Patients from the Chest Pain – MI Registry who had cardiogenic shock at first medical contact or as an in-hospital event were included in the study, as were patients in the CathPCI Registry who had cardiogenic shock within 24 hours before PCI, at the start of the procedure, or during or after the procedure. 

Of 28,304 patients at 928 hospitals, the average age was 65.4 years, and 18,968 (67%) were men. Overall, 12,077 patients (42.7%) received a mechanical circulatory system (MCS) device, while 16,227 (57.3%) received medical therapy only. The overall MCS device use was constant throughout the study period; however, use of intravascular microaxial LVADs increased from 4.1% in 2015 to 9.8% in 2017 and use of IABPs decreased from 34.8% in 2015 to 30% in 2017.

The results showed significant hospital-level variation in MCS device use, with 521 (56.1%) of hospitals not using intravascular microaxial LVADs for patients with AMI complicated by cardiogenic shock. The median proportion of patients who received MCS devices was 42% (30%-54%), and the median proportion of patients who received intravascular microaxial LVADs was 1% (0%-10%). Patient characteristics associated with a higher likelihood of receiving intravascular microaxial LVADs only vs. IABPs only included having cardiac arrest at first medical contact or during hospitalization (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.58-2.09) and severe left main and/or proximal left anterior descending coronary artery stenosis (OR, 1.36; 95% CI, 1.20-1.54).

According to the researchers, the hospital- and device-level variations "seemed to be associated not only with clinical presentation or physiological features but also with discretionary decision-making by physicians and institutions." They conclude that use of intravascular microaxial LVADs increased among patients undergoing PCI for AMI complicated by cardiogenic shock, corresponding with a decrease in use of IABPs, "despite limited clinical trial evidence of improved outcomes associated with device use."

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Implantable Devices, SCD/Ventricular Arrhythmias, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Acute Heart Failure, Mechanical Circulatory Support

Keywords: Shock, Cardiogenic, Heart-Assist Devices, Percutaneous Coronary Intervention, Myocardial Infarction, Registries, National Cardiovascular Data Registries, Heart Arrest, Chest Pain, Chest Pain MI Registry, Coronary Stenosis, Cardiovascular System, Decision Making, CathPCI Registry

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