Use of mechanical circulatory support in patients undergoing percutaneous coronary intervention: insights from the National Cardiovascular Data Registry.
BACKGROUND
Little is known about the contemporary use of intra-aortic balloon pump (IABP) and other mechanical circulatory support (O-MCS) devices in patients undergoing percutaneous coronary intervention (PCI) in the setting of cardiogenic shock.


RESULTS
We identified 76 474 patients who underwent PCI in the setting of cardiogenic shock at one of 1429 National Cardiovascular Data Registry CathPCI participating hospitals from 2009 to 2013. Temporal trends and hospital-level variation in the use of IABP and O-MCS were evaluated. No mechanical circulatory support was used in 41 286 (54%) patients, 29 730 (39%) received IABP only, 2711 (3.5%) received O-MCS only, and 2747 (3.6%) received both IABP and O-MCS. At the start of the study period, 45% of patients undergoing PCI in the setting of cardiogenic shock received an IABP and 6.7% received O-MCS. The proportion of patients receiving IABP declined at an average rate of 0.3% per quarter, whereas the rate of O-MCS use was unchanged over the study period. The predicted probability of IABP use varied significantly by site (hospital median 42%, interquartile range 33% to 51%, range 8% to 85%). The probability of O-MCS use was <5% for half of hospitals and >20% in less than one-tenth of hospitals.


CONCLUSIONS
In this large national registry, the use of IABP in the setting of PCI for cardiogenic shock decreased over time without a concurrent increase in O-MCS use. The probability of IABP and O-MCS use varied across hospitals, and the use of O-MCS was clustered at a small number of hospitals.
From Division of Cardiology, University of Colorado School of Medicine, Aurora (A.S., J.M., S.M.B.); Division of Cardiology, Duke University Medical Center, Durham, NC (L.A.M., T.W.); Division of Cardiology, Medstar Washington Hospital Center/Georgetown University, Washington, DC (S.I.N.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.H., M.M.); Division of Cardiology, Northwestern University, Chicago, IL (P.A.); Division of Cardiology, Weill Cornell Medical Center, New York (S.J.A.'A., R.V.S.); Division of Cardiology, Yale/New Haven Medical Center, CT (J.C.); Division of Cardiology, Kaiser Permanente San Francisco Medical Center, CA (E.M.); Division of Cardiology, University of Texas Health Science Center, Houston (H.V.A.); Division of Cardiology, University of Illinois, Chicago (A.S.); Division of Cardiology, University of Michigan, Ann Arbor (H.G.); and Division of Cardiology, VA Eastern Colorado Health Care System, Denver (J.M., S.M.B.). amneet.sandhu@ucdenver.edu.
Amneet
A
Sandhu
From Division of Cardiology, University of Colorado School of Medicine, Aurora (A.S., J.M., S.M.B.); Division of Cardiology, Duke University Medical Center, Durham, NC (L.A.M., T.W.); Division of Cardiology, Medstar Washington Hospital Center/Georgetown University, Washington, DC (S.I.N.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.H., M.M.); Division of Cardiology, Northwestern University, Chicago, IL (P.A.); Division of Cardiology, Weill Cornell Medical Center, New York (S.J.A.'A., R.V.S.); Division of Cardiology, Yale/New Haven Medical Center, CT (J.C.); Division of Cardiology, Kaiser Permanente San Francisco Medical Center, CA (E.M.); Division of Cardiology, University of Texas Health Science Center, Houston (H.V.A.); Division of Cardiology, University of Illinois, Chicago (A.S.); Division of Cardiology, University of Michigan, Ann Arbor (H.G.); and Division of Cardiology, VA Eastern Colorado Health Care System, Denver (J.M., S.M.B.).
Lisa A
LA
McCoy
From Division of Cardiology, University of Colorado School of Medicine, Aurora (A.S., J.M., S.M.B.); Division of Cardiology, Duke University Medical Center, Durham, NC (L.A.M., T.W.); Division of Cardiology, Medstar Washington Hospital Center/Georgetown University, Washington, DC (S.I.N.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.H., M.M.); Division of Cardiology, Northwestern University, Chicago, IL (P.A.); Division of Cardiology, Weill Cornell Medical Center, New York (S.J.A.'A., R.V.S.); Division of Cardiology, Yale/New Haven Medical Center, CT (J.C.); Division of Cardiology, Kaiser Permanente San Francisco Medical Center, CA (E.M.); Division of Cardiology, University of Texas Health Science Center, Houston (H.V.A.); Division of Cardiology, University of Illinois, Chicago (A.S.); Division of Cardiology, University of Michigan, Ann Arbor (H.G.); and Division of Cardiology, VA Eastern Colorado Health Care System, Denver (J.M., S.M.B.).
Smita I
SI
Negi
From Division of Cardiology, University of Colorado School of Medicine, Aurora (A.S., J.M., S.M.B.); Division of Cardiology, Duke University Medical Center, Durham, NC (L.A.M., T.W.); Division of Cardiology, Medstar Washington Hospital Center/Georgetown University, Washington, DC (S.I.N.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.H., M.M.); Division of Cardiology, Northwestern University, Chicago, IL (P.A.); Division of Cardiology, Weill Cornell Medical Center, New York (S.J.A.'A., R.V.S.); Division of Cardiology, Yale/New Haven Medical Center, CT (J.C.); Division of Cardiology, Kaiser Permanente San Francisco Medical Center, CA (E.M.); Division of Cardiology, University of Texas Health Science Center, Houston (H.V.A.); Division of Cardiology, University of Illinois, Chicago (A.S.); Division of Cardiology, University of Michigan, Ann Arbor (H.G.); and Division of Cardiology, VA Eastern Colorado Health Care System, Denver (J.M., S.M.B.).
Irfan
I
Hameed
From Division of Cardiology, University of Colorado School of Medicine, Aurora (A.S., J.M., S.M.B.); Division of Cardiology, Duke University Medical Center, Durham, NC (L.A.M., T.W.); Division of Cardiology, Medstar Washington Hospital Center/Georgetown University, Washington, DC (S.I.N.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.H., M.M.); Division of Cardiology, Northwestern University, Chicago, IL (P.A.); Division of Cardiology, Weill Cornell Medical Center, New York (S.J.A.'A., R.V.S.); Division of Cardiology, Yale/New Haven Medical Center, CT (J.C.); Division of Cardiology, Kaiser Permanente San Francisco Medical Center, CA (E.M.); Division of Cardiology, University of Texas Health Science Center, Houston (H.V.A.); Division of Cardiology, University of Illinois, Chicago (A.S.); Division of Cardiology, University of Michigan, Ann Arbor (H.G.); and Division of Cardiology, VA Eastern Colorado Health Care System, Denver (J.M., S.M.B.).
Prashant
P
Atri
From Division of Cardiology, University of Colorado School of Medicine, Aurora (A.S., J.M., S.M.B.); Division of Cardiology, Duke University Medical Center, Durham, NC (L.A.M., T.W.); Division of Cardiology, Medstar Washington Hospital Center/Georgetown University, Washington, DC (S.I.N.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.H., M.M.); Division of Cardiology, Northwestern University, Chicago, IL (P.A.); Division of Cardiology, Weill Cornell Medical Center, New York (S.J.A.'A., R.V.S.); Division of Cardiology, Yale/New Haven Medical Center, CT (J.C.); Division of Cardiology, Kaiser Permanente San Francisco Medical Center, CA (E.M.); Division of Cardiology, University of Texas Health Science Center, Houston (H.V.A.); Division of Cardiology, University of Illinois, Chicago (A.S.); Division of Cardiology, University of Michigan, Ann Arbor (H.G.); and Division of Cardiology, VA Eastern Colorado Health Care System, Denver (J.M., S.M.B.).
Subhi J
SJ
Al'Aref
From Division of Cardiology, University of Colorado School of Medicine, Aurora (A.S., J.M., S.M.B.); Division of Cardiology, Duke University Medical Center, Durham, NC (L.A.M., T.W.); Division of Cardiology, Medstar Washington Hospital Center/Georgetown University, Washington, DC (S.I.N.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.H., M.M.); Division of Cardiology, Northwestern University, Chicago, IL (P.A.); Division of Cardiology, Weill Cornell Medical Center, New York (S.J.A.'A., R.V.S.); Division of Cardiology, Yale/New Haven Medical Center, CT (J.C.); Division of Cardiology, Kaiser Permanente San Francisco Medical Center, CA (E.M.); Division of Cardiology, University of Texas Health Science Center, Houston (H.V.A.); Division of Cardiology, University of Illinois, Chicago (A.S.); Division of Cardiology, University of Michigan, Ann Arbor (H.G.); and Division of Cardiology, VA Eastern Colorado Health Care System, Denver (J.M., S.M.B.).
Jeptha
J
Curtis
From Division of Cardiology, University of Colorado School of Medicine, Aurora (A.S., J.M., S.M.B.); Division of Cardiology, Duke University Medical Center, Durham, NC (L.A.M., T.W.); Division of Cardiology, Medstar Washington Hospital Center/Georgetown University, Washington, DC (S.I.N.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.H., M.M.); Division of Cardiology, Northwestern University, Chicago, IL (P.A.); Division of Cardiology, Weill Cornell Medical Center, New York (S.J.A.'A., R.V.S.); Division of Cardiology, Yale/New Haven Medical Center, CT (J.C.); Division of Cardiology, Kaiser Permanente San Francisco Medical Center, CA (E.M.); Division of Cardiology, University of Texas Health Science Center, Houston (H.V.A.); Division of Cardiology, University of Illinois, Chicago (A.S.); Division of Cardiology, University of Michigan, Ann Arbor (H.G.); and Division of Cardiology, VA Eastern Colorado Health Care System, Denver (J.M., S.M.B.).
Ed
E
McNulty
From Division of Cardiology, University of Colorado School of Medicine, Aurora (A.S., J.M., S.M.B.); Division of Cardiology, Duke University Medical Center, Durham, NC (L.A.M., T.W.); Division of Cardiology, Medstar Washington Hospital Center/Georgetown University, Washington, DC (S.I.N.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.H., M.M.); Division of Cardiology, Northwestern University, Chicago, IL (P.A.); Division of Cardiology, Weill Cornell Medical Center, New York (S.J.A.'A., R.V.S.); Division of Cardiology, Yale/New Haven Medical Center, CT (J.C.); Division of Cardiology, Kaiser Permanente San Francisco Medical Center, CA (E.M.); Division of Cardiology, University of Texas Health Science Center, Houston (H.V.A.); Division of Cardiology, University of Illinois, Chicago (A.S.); Division of Cardiology, University of Michigan, Ann Arbor (H.G.); and Division of Cardiology, VA Eastern Colorado Health Care System, Denver (J.M., S.M.B.).
H Vernon
HV
Anderson
From Division of Cardiology, University of Colorado School of Medicine, Aurora (A.S., J.M., S.M.B.); Division of Cardiology, Duke University Medical Center, Durham, NC (L.A.M., T.W.); Division of Cardiology, Medstar Washington Hospital Center/Georgetown University, Washington, DC (S.I.N.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.H., M.M.); Division of Cardiology, Northwestern University, Chicago, IL (P.A.); Division of Cardiology, Weill Cornell Medical Center, New York (S.J.A.'A., R.V.S.); Division of Cardiology, Yale/New Haven Medical Center, CT (J.C.); Division of Cardiology, Kaiser Permanente San Francisco Medical Center, CA (E.M.); Division of Cardiology, University of Texas Health Science Center, Houston (H.V.A.); Division of Cardiology, University of Illinois, Chicago (A.S.); Division of Cardiology, University of Michigan, Ann Arbor (H.G.); and Division of Cardiology, VA Eastern Colorado Health Care System, Denver (J.M., S.M.B.).
Adhir
A
Shroff
From Division of Cardiology, University of Colorado School of Medicine, Aurora (A.S., J.M., S.M.B.); Division of Cardiology, Duke University Medical Center, Durham, NC (L.A.M., T.W.); Division of Cardiology, Medstar Washington Hospital Center/Georgetown University, Washington, DC (S.I.N.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.H., M.M.); Division of Cardiology, Northwestern University, Chicago, IL (P.A.); Division of Cardiology, Weill Cornell Medical Center, New York (S.J.A.'A., R.V.S.); Division of Cardiology, Yale/New Haven Medical Center, CT (J.C.); Division of Cardiology, Kaiser Permanente San Francisco Medical Center, CA (E.M.); Division of Cardiology, University of Texas Health Science Center, Houston (H.V.A.); Division of Cardiology, University of Illinois, Chicago (A.S.); Division of Cardiology, University of Michigan, Ann Arbor (H.G.); and Division of Cardiology, VA Eastern Colorado Health Care System, Denver (J.M., S.M.B.).
Mark
M
Menegus
From Division of Cardiology, University of Colorado School of Medicine, Aurora (A.S., J.M., S.M.B.); Division of Cardiology, Duke University Medical Center, Durham, NC (L.A.M., T.W.); Division of Cardiology, Medstar Washington Hospital Center/Georgetown University, Washington, DC (S.I.N.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.H., M.M.); Division of Cardiology, Northwestern University, Chicago, IL (P.A.); Division of Cardiology, Weill Cornell Medical Center, New York (S.J.A.'A., R.V.S.); Division of Cardiology, Yale/New Haven Medical Center, CT (J.C.); Division of Cardiology, Kaiser Permanente San Francisco Medical Center, CA (E.M.); Division of Cardiology, University of Texas Health Science Center, Houston (H.V.A.); Division of Cardiology, University of Illinois, Chicago (A.S.); Division of Cardiology, University of Michigan, Ann Arbor (H.G.); and Division of Cardiology, VA Eastern Colorado Health Care System, Denver (J.M., S.M.B.).
Rajesh V
RV
Swaminathan
From Division of Cardiology, University of Colorado School of Medicine, Aurora (A.S., J.M., S.M.B.); Division of Cardiology, Duke University Medical Center, Durham, NC (L.A.M., T.W.); Division of Cardiology, Medstar Washington Hospital Center/Georgetown University, Washington, DC (S.I.N.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.H., M.M.); Division of Cardiology, Northwestern University, Chicago, IL (P.A.); Division of Cardiology, Weill Cornell Medical Center, New York (S.J.A.'A., R.V.S.); Division of Cardiology, Yale/New Haven Medical Center, CT (J.C.); Division of Cardiology, Kaiser Permanente San Francisco Medical Center, CA (E.M.); Division of Cardiology, University of Texas Health Science Center, Houston (H.V.A.); Division of Cardiology, University of Illinois, Chicago (A.S.); Division of Cardiology, University of Michigan, Ann Arbor (H.G.); and Division of Cardiology, VA Eastern Colorado Health Care System, Denver (J.M., S.M.B.).
Hitinder
H
Gurm
From Division of Cardiology, University of Colorado School of Medicine, Aurora (A.S., J.M., S.M.B.); Division of Cardiology, Duke University Medical Center, Durham, NC (L.A.M., T.W.); Division of Cardiology, Medstar Washington Hospital Center/Georgetown University, Washington, DC (S.I.N.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.H., M.M.); Division of Cardiology, Northwestern University, Chicago, IL (P.A.); Division of Cardiology, Weill Cornell Medical Center, New York (S.J.A.'A., R.V.S.); Division of Cardiology, Yale/New Haven Medical Center, CT (J.C.); Division of Cardiology, Kaiser Permanente San Francisco Medical Center, CA (E.M.); Division of Cardiology, University of Texas Health Science Center, Houston (H.V.A.); Division of Cardiology, University of Illinois, Chicago (A.S.); Division of Cardiology, University of Michigan, Ann Arbor (H.G.); and Division of Cardiology, VA Eastern Colorado Health Care System, Denver (J.M., S.M.B.).
John
J
Messenger
From Division of Cardiology, University of Colorado School of Medicine, Aurora (A.S., J.M., S.M.B.); Division of Cardiology, Duke University Medical Center, Durham, NC (L.A.M., T.W.); Division of Cardiology, Medstar Washington Hospital Center/Georgetown University, Washington, DC (S.I.N.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.H., M.M.); Division of Cardiology, Northwestern University, Chicago, IL (P.A.); Division of Cardiology, Weill Cornell Medical Center, New York (S.J.A.'A., R.V.S.); Division of Cardiology, Yale/New Haven Medical Center, CT (J.C.); Division of Cardiology, Kaiser Permanente San Francisco Medical Center, CA (E.M.); Division of Cardiology, University of Texas Health Science Center, Houston (H.V.A.); Division of Cardiology, University of Illinois, Chicago (A.S.); Division of Cardiology, University of Michigan, Ann Arbor (H.G.); and Division of Cardiology, VA Eastern Colorado Health Care System, Denver (J.M., S.M.B.).
Tracy
T
Wang
From Division of Cardiology, University of Colorado School of Medicine, Aurora (A.S., J.M., S.M.B.); Division of Cardiology, Duke University Medical Center, Durham, NC (L.A.M., T.W.); Division of Cardiology, Medstar Washington Hospital Center/Georgetown University, Washington, DC (S.I.N.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.H., M.M.); Division of Cardiology, Northwestern University, Chicago, IL (P.A.); Division of Cardiology, Weill Cornell Medical Center, New York (S.J.A.'A., R.V.S.); Division of Cardiology, Yale/New Haven Medical Center, CT (J.C.); Division of Cardiology, Kaiser Permanente San Francisco Medical Center, CA (E.M.); Division of Cardiology, University of Texas Health Science Center, Houston (H.V.A.); Division of Cardiology, University of Illinois, Chicago (A.S.); Division of Cardiology, University of Michigan, Ann Arbor (H.G.); and Division of Cardiology, VA Eastern Colorado Health Care System, Denver (J.M., S.M.B.).
Steven M
SM
Bradley
D000368:Aged; D000369:Aged, 80 and over; D001243:Assisted Circulation / Q000706:statistics & numerical data* / Q000639:trends; D015897:Comorbidity; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000706:statistics & numerical data / Q000639:trends; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000628:therapy; D012955:Societies, Medical; D014481:United States
advanced cardiac life support; high-risk percutaneous coronary intervention; intra-aortic balloon pump; percutaneous coronary intervention; shock, cardiogenic