Journal article
Use of Mechanical Circulatory Support in Percutaneous Coronary Intervention in the United States
The American journal of cardiology, Vol.117(1), pp.10-16
01/01/2016
DOI: 10.1016/j.amjcard.2015.10.005
PMCID: PMC4690753
PMID: 26547292
Abstract
Percutaneous ventricular assist devices (PVADs) and intraaortic balloon pump (IABP) are used to provide mechanical circulatory support (MCS) for high-risk percutaneous coronary intervention (PCI). Contemporary trends in their utilization and impact on in-hospital mortality are not known. Using the National Inpatient Sample (2004 to 2012), we identified 5,031 patients who received a PVAD and 122,333 who received an IABP on the same day as PCI using International Classification of Diseases, Ninth Edition codes. Utilization of MCS increased from 1.3% of all PCIs in 2004 to 3.4% in 2012 (p trend <0.001), with increase in the use of both PVAD (<1/10,000 PCIs [2004 to 2007] to 38/10,000 [2012]) and IABP (132/10,000 PCIs [2004] to 299/10,000[2012] p <0.0001 for both). PVAD recipients were older (69 vs 65 years), more likely to have heart failure (68% vs 41%), chronic kidney disease (27% vs 11%, p <0.001 for all), and be admitted electively (30% vs 11%), but less likely to have acute myocardial infarction (52% vs 90%), cardiogenic shock (23% vs 50%), or need mechanical ventilation (16% vs 29%) compared with IABP recipients. Unadjusted in-hospital mortality was lower in PVAD compared with IABP recipients (12.8% vs 20.9%, p <0.001). However, in propensity-matched analyses (1:2), in-hospital mortality was similar in both groups (odds ratio 0.88, 95% confidence interval 0.70 to 1.09). In conclusion, there has been a marked increase in the utilization of MCS in patients undergoing PCI. Unadjusted mortality using PVADs is lower than IABP but may be due to their selective use in patients at lower risk. Randomized trials are necessary to establish their effectiveness in supporting high-risk PCI.
Details
- Title: Subtitle
- Use of Mechanical Circulatory Support in Percutaneous Coronary Intervention in the United States
- Creators
- Rohan Khera - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa. Electronic address: rohan-khera@uiowa.eduPeter Cram - Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of General Internal Medicine, University Health Network/ Mount Sinai Hospital, Toronto, Ontario, CanadaMary Vaughan-Sarrazin - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa; Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa; Institute of Clinical and Translational Science, University of Iowa Carver College of Medicine, Iowa City, IowaPhillip A Horwitz - Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IowaSaket Girotra - Institute of Clinical and Translational Science, University of Iowa Carver College of Medicine, Iowa City, Iowa; Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
- Resource Type
- Journal article
- Publication Details
- The American journal of cardiology, Vol.117(1), pp.10-16
- DOI
- 10.1016/j.amjcard.2015.10.005
- PMID
- 26547292
- PMCID
- PMC4690753
- NLM abbreviation
- Am J Cardiol
- ISSN
- 0002-9149
- eISSN
- 1879-1913
- Publisher
- United States
- Grant note
- K24 AR062133 / NIAMS NIH HHS K08HL122527 / NHLBI NIH HHS K08 HL122527 / NHLBI NIH HHS
- Language
- English
- Date published
- 01/01/2016
- Academic Unit
- Health Management and Policy; Cardiovascular Medicine; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984063134902771
Metrics
21 Record Views