title: Use of Mechanical Circulatory Support in Percutaneous Coronary Intervention in the United States.
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.
authors.affiliation: Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa. Electronic address: rohan-khera@uiowa.edu.
authors.forename: Rohan
authors.initials: R
authors.lastname: Khera
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of General Internal Medicine, University Health Network/ Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Cram
authors.affiliation: 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, Iowa.
authors.forename: Mary
authors.initials: M
authors.lastname: Vaughan-Sarrazin
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
authors.forename: Phillip A
authors.initials: PA
authors.lastname: Horwitz
authors.affiliation: 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.
authors.forename: Saket
authors.initials: S
authors.lastname: Girotra
mesh_terms: D000368:Aged; D005260:Female; D006353:Heart-Assist Devices; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000601:surgery*; D062645:Percutaneous Coronary Intervention; D012189:Retrospective Studies; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000401:mortality / Q000517:prevention & control*; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology