Abstract 13507: Outcomes Among Coronary Artery Disease Patients Hospitalized for Left Ventricular Assist Device Implantation: A United States Population-Based Cohort Study

Abstract

Introduction: Coronary Artery Disease (CAD) is a significant cause of morbidity and mortality among the general population. Previous studies suggested that significant CAD increased the risk for adverse outcomes including acute coronary syndrome and ischemic cardiomyopathy, which if severe enough warrants advance therapeutic options including implantation of a left ventricular assist device (LVAD). However, there is paucity of data exploring the in-hospital outcomes of patients with CAD admitted for LVAD implantation. Hypothesis: CAD does not impact outcomes in patients undergoing LVAD implantation. Methods: A retrospective cohort study using the National Inpatient Sample 2018-2020 database. Patients aged > 18 years with known CAD admitted for LVAD placement were identified in the database. Multivariate logistic regression analysis was used to adjust for potential patients' and hospital level confounders. Outcome of interest were in-hospital mortality, ST-Elevation Myocardial Infarction (STEMI), LVAD thrombosis and ischemic stroke among patients with CAD hospitalized for LVAD implantation. Results: We identified a total of 76,757 patients admitted for LVAD implantation in the years 2018-2020, of which 55.93% (n= 42,930/76,757) had CAD. The overall mortality rate among patients admitted for LVAD implantation was 27.47% (n=21,080/76,757). Among those with concomitant CAD, the mortality rate was significantly higher at 28.93% (12,263/42,930, P=0.00). Using a stepwise survey multivariable logistic regression model that adjusted for patient and hospital level confounders, concomitant CAD among LVAD recipients was found to be an independent predictor of overall in-hospital mortality (aOR 1.24; 95% CI (Confidence Interval), 1.14-1.36; p<0.001) but did not increase the risk of STEMI (aOR 1.48; 95% CI, 0.98-1.34; p=0.09), LVAD thrombosis (aOR 1.04; 95% CI, 0.51-2.14; p=0.91) and ischemic stroke (aOR 0.76; 95% CI, 0.38-1.39; p=0.33). Conclusions: Among hospitalized patients for LVAD implantation, concurrent CAD increased the risk for in-hospital mortality but did not increase the risk for STEMI, LVAD thrombosis and ischemic stroke. Prospective studies with control of potential confounders may better delineate these associations.