Abstract 13101: Bleeding Complications in Patients Undergoing Percutaneous Coronary Intervention With Intra-Aortic Balloon Pump and/or Impella Support: A System Wide Analysis

Abstract

Background: Mechanical circulatory support (MCS) devices are used to provide temporary hemodynamic support in patients undergoing percutaneous coronary interventions (PCI). Currently, the most used percutaneous devices are the intra-aortic balloon pump (IABP) and the Impella micro-axial flow device. Aim: To assess bleeding complications associated with IABP and/or Impella in patients undergoing PCI. Methods: Between 12/2010 and 03/2018 a total of 883 patient underwent PCI with MCS at 6 hospitals in our system. Patients were divided into three groups: IABP (n=679), Impella (n=171) and IABP with Impella (n=33). Bleeding complications were classified according to the Bleeding Academic Research Consortium (BARC). BARC Type 4 (coronary bypass grafting-related) and BARC Type 5 (fatal bleeding) bleeding events were excluded. Chi-square tests and logistic regression were utilized with p<0.05 significance level. Multiple pairwise comparisons using Bonferroni-adjusted p-value threshold of p<0.0167 for level of significance was also performed. A multiple variable analysis will be presented. Results: Clinical characteristics, bleeding complications and in-hospital outcomes are shown in the Table. There were significant differences in these variables except age and gender among the three groups. A minority of patients (4%) were treated simultaneously with both devices, however 45% of these patients had a significant bleeding event and 33% died in the hospital. No significant difference in bleeding complications between IABP and Impella (each alone) was found (p=0.38). Conclusions: In patients undergoing PCI, use of a combination of IABP and Impella was associated with significantly higher rate of intermediate or major bleeding complications when compared with patients treated with either device alone. Furthermore, these patients had significantly higher in-hospital mortality rates.