Mechanical Circulatory Support in Patients Without Cardiogenic Shock Undergoing Percutaneous Coronary Intervention
Background The use of mechanical circulatory support devices for high‐risk percutaneous coronary intervention (PCI) has increased over the past decade despite limited data of benefit. We sought to examine the association between intravascular microaxial left ventricular assist device (LVAD) versus i...
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Wiley
2025-01-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.037424 |
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| author | P. Elliott Miller Aliza S. Gordon Ying Liu Tariq Ahmad Samantha G. Bromfield Saket Girotra Carlos D. Davila Geoffrey Crawford John Whitney Nihar R. Desai |
| author_facet | P. Elliott Miller Aliza S. Gordon Ying Liu Tariq Ahmad Samantha G. Bromfield Saket Girotra Carlos D. Davila Geoffrey Crawford John Whitney Nihar R. Desai |
| author_sort | P. Elliott Miller |
| collection | DOAJ |
| description | Background The use of mechanical circulatory support devices for high‐risk percutaneous coronary intervention (PCI) has increased over the past decade despite limited data of benefit. We sought to examine the association between intravascular microaxial left ventricular assist device (LVAD) versus intra‐aortic balloon pump use in patients without cardiogenic shock (CS) undergoing PCI. Methods and Results This retrospective study analyzed claims data from a large, insured population who underwent PCI without CS from April 1, 2016 to July 31, 2022. Using inverse probability treatment weighting, we assessed for the association between device type and clinical outcomes. The primary outcome was all‐cause mortality. Secondary outcomes included stroke, bleeding, incident dialysis, repeat revascularization, and total health care costs during the index admission and at 30 days. We identified 2879 patients without CS who underwent PCI with either an intra‐aortic balloon pump or microaxial LVAD. The mean±SD age was 68.2±12.5 years, and 27% (n=764) were women. After propensity weighting, intravascular LVAD use was not associated with a significant difference in either in‐hospital (odds ratio [OR] 1.30 [95% CI, 0.88–1.91]; P=0.19) or 30‐day mortality (OR, 1.19 [95% CI, 0.84–1.69]; P=0.33) compared with intra‐aortic balloon pump use. Compared with those receiving an intra‐aortic balloon pump, the mean total costs for the index admission ($96 716 versus $71 892; P<0.001) and at 30 days (+$16 671 [95% CI, $6639–$28 103]; P=0.001) were significantly higher in those receiving an intravascular LVAD. There was no significant association between device type and stroke, bleeding, incident dialysis, and repeat revascularization at any time point (all P>0.05). Conclusions In patients without CS undergoing PCI, intravascular LVAD use was associated with higher costs but not associated with lower mortality. Randomized data are needed to improve device selection for patients without CS undergoing PCI. |
| format | Article |
| id | doaj-art-6daf7b60bee0404f97628829d265d1c3 |
| institution | Kabale University |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-6daf7b60bee0404f97628829d265d1c32025-08-20T03:24:33ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-01-0114210.1161/JAHA.124.037424Mechanical Circulatory Support in Patients Without Cardiogenic Shock Undergoing Percutaneous Coronary InterventionP. Elliott Miller0Aliza S. Gordon1Ying Liu2Tariq Ahmad3Samantha G. Bromfield4Saket Girotra5Carlos D. Davila6Geoffrey Crawford7John Whitney8Nihar R. Desai9Section of Cardiovascular Medicine Yale School of Medicine New Haven CT USAPublic Policy Institute, Elevance Health Indianapolis IN USAPublic Policy Institute, Elevance Health Indianapolis IN USASection of Cardiovascular Medicine Yale School of Medicine New Haven CT USAPublic Policy Institute, Elevance Health Indianapolis IN USADivision of Cardiology University of Texas Southwestern Medical Center Dallas TX USASection of Cardiovascular Medicine Yale School of Medicine New Haven CT USAMedical Policy & Technology Assessment Elevance Health Indianapolis IN USAMedical Policy & Technology Assessment Elevance Health Indianapolis IN USASection of Cardiovascular Medicine Yale School of Medicine New Haven CT USABackground The use of mechanical circulatory support devices for high‐risk percutaneous coronary intervention (PCI) has increased over the past decade despite limited data of benefit. We sought to examine the association between intravascular microaxial left ventricular assist device (LVAD) versus intra‐aortic balloon pump use in patients without cardiogenic shock (CS) undergoing PCI. Methods and Results This retrospective study analyzed claims data from a large, insured population who underwent PCI without CS from April 1, 2016 to July 31, 2022. Using inverse probability treatment weighting, we assessed for the association between device type and clinical outcomes. The primary outcome was all‐cause mortality. Secondary outcomes included stroke, bleeding, incident dialysis, repeat revascularization, and total health care costs during the index admission and at 30 days. We identified 2879 patients without CS who underwent PCI with either an intra‐aortic balloon pump or microaxial LVAD. The mean±SD age was 68.2±12.5 years, and 27% (n=764) were women. After propensity weighting, intravascular LVAD use was not associated with a significant difference in either in‐hospital (odds ratio [OR] 1.30 [95% CI, 0.88–1.91]; P=0.19) or 30‐day mortality (OR, 1.19 [95% CI, 0.84–1.69]; P=0.33) compared with intra‐aortic balloon pump use. Compared with those receiving an intra‐aortic balloon pump, the mean total costs for the index admission ($96 716 versus $71 892; P<0.001) and at 30 days (+$16 671 [95% CI, $6639–$28 103]; P=0.001) were significantly higher in those receiving an intravascular LVAD. There was no significant association between device type and stroke, bleeding, incident dialysis, and repeat revascularization at any time point (all P>0.05). Conclusions In patients without CS undergoing PCI, intravascular LVAD use was associated with higher costs but not associated with lower mortality. Randomized data are needed to improve device selection for patients without CS undergoing PCI.https://www.ahajournals.org/doi/10.1161/JAHA.124.037424acute myocardial infarctionhigh‐risk PCImechanical circulatory support |
| spellingShingle | P. Elliott Miller Aliza S. Gordon Ying Liu Tariq Ahmad Samantha G. Bromfield Saket Girotra Carlos D. Davila Geoffrey Crawford John Whitney Nihar R. Desai Mechanical Circulatory Support in Patients Without Cardiogenic Shock Undergoing Percutaneous Coronary Intervention Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease acute myocardial infarction high‐risk PCI mechanical circulatory support |
| title | Mechanical Circulatory Support in Patients Without Cardiogenic Shock Undergoing Percutaneous Coronary Intervention |
| title_full | Mechanical Circulatory Support in Patients Without Cardiogenic Shock Undergoing Percutaneous Coronary Intervention |
| title_fullStr | Mechanical Circulatory Support in Patients Without Cardiogenic Shock Undergoing Percutaneous Coronary Intervention |
| title_full_unstemmed | Mechanical Circulatory Support in Patients Without Cardiogenic Shock Undergoing Percutaneous Coronary Intervention |
| title_short | Mechanical Circulatory Support in Patients Without Cardiogenic Shock Undergoing Percutaneous Coronary Intervention |
| title_sort | mechanical circulatory support in patients without cardiogenic shock undergoing percutaneous coronary intervention |
| topic | acute myocardial infarction high‐risk PCI mechanical circulatory support |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.037424 |
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