Outcomes of nonemergent percutaneous coronary intervention requiring mechanical circulatory support in patients without cardiogenic shock

Al-khadra, Yasser; Alraies, M. Chadi; Darmoch, Fahed; Pacha, Homam M.; Soud, Mohamad; Kaki, Amir; Rab, Tanveer; Grines, Cindy L.; Meraj, Pewaiz; Alaswad, Khaldoon; Kwok, Chun S.; Mamas, Mamas; Kapadia, Samir

Abstract

Background
The utilization of mechanical circulatory support (MCS) for percutaneous coronary intervention (PCI) using percutaneous ventricular assist device (PVAD) or intra-aortic balloon pump (IABP) has been increasing. We sought to evaluate the outcome of coronary intervention using PVAD compared with IABP in noncardiogenic shock and nonacute myocardial infarction patients.

Method
Using the National Inpatient Sampling (NIS) database from 2005 to 2014, we identified patients who underwent PCI using ICD 9 codes. Patients with cardiogenic shock, acute coronary syndrome, or acute myocardial infarction were excluded. Patient was stratified based on the MCS used, either to PVAD or IABP. Univariate and multivariate logistic regression were performed to study PCI outcome using PVAD compared with IABP.

Results
Out of 21,848 patients who underwent PCI requiring MCS, 17,270 (79.0%) patients received IABP and 4,578 (21%) patients received PVAD. PVAD patients were older (69 vs. 67, p < .001), were less likely to be women (23.3% vs. 33.3%, p < .001), and had higher rates of hypertension, diabetes, hyperlipidemia prior PCI, prior coronary artery bypass graft surgery, anemia, chronic lung disease, liver disease, renal failure, and peripheral vascular disease compared with IABP group (p ≤ .007). Using Multivariate logistic regression, PVAD patients had lower in-hospital mortality (6.1% vs. 8.8%, adjusted odds ratio [aOR] 0.62; 95% CI 0.51, 0.77, p < .001), vascular complications (4.3% vs. 7.5%, aOR 0.78; 95% CI 0.62, 0.99, p = .046), cardiac complications (5.6% vs. 14.5%, aOR 0.29; 95% CI 0.24, 0.36, p < .001), and respiratory complications (3.8% vs. 9.8%, aOR 0.37; 95% CI 0.28, 0.48, p < .001) compared with patients who received IABP.

Conclusion
Despite higher comorbidities, nonemergent PCI procedures using PVAD were associated with lower mortality compared with IABP.

Citation

Al-khadra, Y., Alraies, M. C., Darmoch, F., Pacha, H. M., Soud, M., Kaki, A., …Kapadia, S. (2020). Outcomes of nonemergent percutaneous coronary intervention requiring mechanical circulatory support in patients without cardiogenic shock. Catheterization and Cardiovascular Interventions, 95(3), 503-512. https://doi.org/10.1002/ccd.28383

• Journal Article Type: Article
• Acceptance Date: Jun 17, 2019
• Online Publication Date: Jun 28, 2019
• Publication Date: Feb 15, 2020
• Deposit Date: Jun 26, 2023
• Journal: CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS
• Print ISSN: 1522-1946
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 95
• Issue: 3
• Pages: 503-512
• DOI: https://doi.org/10.1002/ccd.28383