Alejandro Lemor1, Seyed Hamed Hosseini Dehkordi2, Mir B Basir3, Pedro A Villablanca3, Tarun Jain4, Gerald C Koenig5, Khaldoon Alaswad3, Jeffrey W Moses6, Navin K Kapur7, William O'Neill3. 1. Department of Cardiology, Henry Ford Hospital, Detroit, MI, United States of America; Universidad de San Martín de Porres, Facultad de Medicina, Centro de Investigación de Epidemiología Clínica y Medicina Basada en la Evidencia, Lima, Peru. Electronic address: alejandrolemor@outlook.com. 2. Department of Cardiology, The University of Kansas Health System, Kansas City, KS, United States of America. 3. Department of Cardiology, Henry Ford Hospital, Detroit, MI, United States of America. 4. Department of Cardiology, Mount Sinai Hospital, New York, NY, United States of America. 5. Department of Cardiology, Henry Ford Hospital, Detroit, MI, United States of America; Wayne State University, School of Medicine, Detroit, MI, United States of America. 6. Department of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, NY, United States of America. 7. The CardioVascular Center, Tufts Medical Center, Boston, MA, United States of America.
Abstract
BACKGROUND: Percutaneous ventricular assist devices and extracorporeal membrane oxygenation (ECMO) are increasingly used for mechanical circulatory support (MCS) in patients with acute myocardial infarction with cardiogenic shock (AMI-CS) in hospitals throughout the United States. METHODS: Using the National Inpatient Sample from October 2015 to December 2017, we identified hospital admissions that underwent percutaneous coronary intervention (PCI) and non-elective Impella or ECMO placement for AMI-CS using ICD-10 codes. Propensity-score matching was performed to compare both groups for primary and secondary outcomes. RESULTS: We identified 6290 admissions for AMI-CS who underwent PCI and were treated with Impella (n = 5730, 91%) or ECMO (n = 560, 9%) from October 2015 to December 2017. After propensity-match analysis, the ECMO cohort had significantly higher in-hospital mortality (43.3% vs 26.7%, OR: 2.10, p = 0.021). The incidence of acute respiratory failure and vascular complications were significantly lower in the Impella cohort. We observed a shorter duration of hospital stay and lower hospital costs in the Impella cohort compared to those who received ECMO. CONCLUSIONS: In AMI-CS, the use of Impella was associated with better clinical outcomes, fewer complications, shorter length of hospital stay and lower hospital cost compared to those undergoing ECMO placement.
BACKGROUND: Percutaneous ventricular assist devices and extracorporeal membrane oxygenation (ECMO) are increasingly used for mechanical circulatory support (MCS) in patients with acute myocardial infarction with cardiogenic shock (AMI-CS) in hospitals throughout the United States. METHODS: Using the National Inpatient Sample from October 2015 to December 2017, we identified hospital admissions that underwent percutaneous coronary intervention (PCI) and non-elective Impella or ECMO placement for AMI-CS using ICD-10 codes. Propensity-score matching was performed to compare both groups for primary and secondary outcomes. RESULTS: We identified 6290 admissions for AMI-CS who underwent PCI and were treated with Impella (n = 5730, 91%) or ECMO (n = 560, 9%) from October 2015 to December 2017. After propensity-match analysis, the ECMO cohort had significantly higher in-hospital mortality (43.3% vs 26.7%, OR: 2.10, p = 0.021). The incidence of acute respiratory failure and vascular complications were significantly lower in the Impella cohort. We observed a shorter duration of hospital stay and lower hospital costs in the Impella cohort compared to those who received ECMO. CONCLUSIONS: In AMI-CS, the use of Impella was associated with better clinical outcomes, fewer complications, shorter length of hospital stay and lower hospital cost compared to those undergoing ECMO placement.
Authors: Riley J Batchelor; Andrew Wheelahan; Wayne C Zheng; Dion Stub; Yang Yang; William Chan Journal: J Clin Med Date: 2022-07-07 Impact factor: 4.964