Abstract 15622: Impella Use in Patients With Cardiogenic Shock is Associated With the Highest Inpatient Mortality in Comparison to Lowest Mortality Seen With the Use of Intraaortic Balloon Pump Using Large Nationwide Inpatient Sample (NIS) Database

Abstract

Introduction: Impella and intra-aortic balloon pumps (IABP) are commonly used in patients with cardiogenic shock. However, the effect on mortality in this population has not been well established. Hypothesis: To evaluate the effect of Impella or IABP on mortality in patients with cardiogenic shock. Methods: We utilized the very large Nationwide Inpatient Sample (NIS) database to evaluate any association between the use of IABP or Impella on mortality in adults with cardiogenic shocks using uni- and multivariate analysis adjusting for comorbid conditions. Results: ICD-10 codes for Impella, IABP, and cardiogenic shock for available years 2016-2020 were utilized. A total of 844,020 patients had a cardiogenic shock. 101,870 (mean age 65.2) were treated with IABP and 39,645 (mean age 64.4) with an Impella. Total inpatient mortality without any device was 34.2% vs only 25.1% with IABP but was highest 40.7% with Impella. Using multivariate analysis adjusting for age, gender, race, three-vessel intervention, left main myocardial infarction, cardiomyopathy, systolic heart failure, acute ST-elevation myocardial infarction, peripheral vascular disease, chronic renal disease, diabetes, and smoking, Impella utilization remained associated with the highest mortality (OR: 1.56, CI 1.48-1.64, p<0.001) whereas IABP remained associated with the lowest mortality (OR: 0.69, CI 0.66-0.72, p<0.001). Conclusions: Using the largest database of its kind revealed that the use of Impella was associated with much higher mortality compared to no use as opposed to utilization of IABP showing the lowest mortality in patients with cardiogenic shock.