Abstract 11620: Long-Term Outcomes and Cost for Impella Compared to Intra-Aortic Balloon Pump in Patients Presenting with Acute Myocardial Infarction Complicated by Cardiogenic Shock

Abstract

Introduction: Recent reports have demonstrated an association between Impella compared to IABP use with increased risk for short-term clinical outcomes, including stroke, bleeding, and mortality among patients with AMI and cardiogenic shock (CS) undergoing PCI. Data on long-term outcomes and cost are limited. Methods: This retrospective study analyzed administrative claims data from a large commercially insured population from 14 states. Patients undergoing PCI for AMI complicated by CS from 7/1/14 to 4/30/20 were included. Those who had both devices or other mechanical circulatory support were excluded. We performed a 1:1 propensity score-matched analysis in patients receiving an Impella versus IABP. The primary outcome was mortality, and secondary outcomes were stroke, bleeding, repeat revascularization, incident dialysis, and cost at 30-days and 1-year follow-up. Results: Of the 3,347 patients undergoing PCI for AMI complicated by CS, the mean (SD) age was 65.4 (12.5) years, 71% were men, and 32% had a cardiac arrest. Among 820 propensity-matched pairs, at 30-days use of the Impella was associated with a significantly higher mortality (Odds ratio [OR] 1.91; 95% Confidence interval [CI]: 1.54-2.37, P <0.001), incident dialysis (OR 1.55; 95% CI:1.10-2.18, P =0.01), and mean difference in cost ($40,869, Interquartile range: $20,829-$64,200, P <0.001) compared to IABP ( Figure ). Incident stroke, bleeding, and repeat revascularization were not different between groups ( P >0.05). At 1-year, mortality (Hazard ratio [HR] 1.58, 95% CI: 1.33-1.87, P <0.001) and incident dialysis (HR 1.70, 95% CI: 1.25-2.30, P =0.001) remained higher in Impella. Conclusions: In patients undergoing PCI for AMI complicated by CS, use of Impella was associated with an increased 30-day and 1-year mortality, dialysis, and cost compared to IABP. There is need for additional evidence surrounding the optimal management of patients with AMI and CS undergoing PCI.