Abstract 169: Contemporary Trends in Utilization and Outcomes of Percutaneous Ventricular Assist Devices in Cardiogenic Shock Complicating ST-Elevation Myocardial Infarction in the United States

Abstract

Background: Percutaneous ventricular assist devices (pVAD) can be rapidly deployed in cardiac catheterization laboratory and have emerged as an effective modality for short-term hemodynamic support in patients with cardiogenic shock. There are limited data on contemporary trends in utilization and outcomes of pVAD in patients with cardiogenic shock complicating ST-elevation myocardial infarction (STEMI). Objectives: To determine the temporal trends in utilization and outcomes of pVAD in patients with cardiogenic shock complicating STEMI. Methods: We queried the 2007-2011 Nationwide Inpatient Sample databases to identify all patients aged ≥ 18 years with STEMI and cardiogenic shock. Patients who underwent pVAD implantation were then identified using ICD-9 procedure code 37.68. Temporal trends in utilization of pVAD in STEMI patients with cardiogenic shock and in-hospital outcomes in these patients were analyzed. Results: From 2007-2011, of 1,053,161 patients with STEMI, 100,881 (9.6%) had cardiogenic shock. The in-hospital mortality in patients with cardiogenic shock decreased from 39.2% in 2007 to 33.9% in 2011 (P trend <0.001, adjusted OR [per year] 0.98, 95% CI 0.97-0.99). Of the STEMI patients with cardiogenic shock, a total of 1,068 (1.1%) patients underwent pVAD implantation. The use of pVAD in STEMI patients with cardiogenic shock increased from 0.1% in 2007 to 2.6% in 2011 (P trend <0.001). The incidence of acute cerebrovascular accident in patients with pVAD was 6.7% with no significant temporal change in incidence (P trend =0.99). The incidence of acute gastrointestinal bleeding in these patients was 14.3% with no significant temporal change in incidence (P trend =0.52). The overall in-hospital mortality in patients who received pVAD was 49.6% with an increase in in-hospital mortality during the study period (P trend =0.03, adjusted OR [per year] 1.22, 95% CI 1.02-1.47). The average length of stay in these patients increased from 12 days to 15 days (P trend <0.001), whereas the average total hospital charges increased from $180,849 to $361,050 (P trend <0.001). Conclusion: In recent years, there has been an increase in utilization of pVAD in patients with cardiogenic shock complicating STEMI. However, this trend was not accompanied with a decrease in overall in-hospital mortality among patients who underwent pVAD implantation. There were also adverse temporal trends in the average length of stay and average hospital cost in STEMI patients with cardiogenic shock undergoing pVAD implantation.