Abstract 17381: Comparative Analysis of Mechanical Circulatory Support in Patients With Acute Coronary Artery Syndrome Induced Cardiogenic Shock

Abstract

Introduction: The relative safety of contemporary, real-world use of percutaneous ventricular assist device (pVAD) and intra aortic balloon pump (IABP) in patients with acute coronary artery syndrome (ACS) induced cardiogenic shock remains unknown. Hypothesis: Outcomes of pVAD and IABP in ACS Methods: Data were obtained from the Nationwide Inpatient Sample (NIS) database (2011-2014) using ICD-9 codes. Patients with the renal transplant or chronic kidney disease were excluded. Categorical and continuous data were compared using unadjusted odds ratio (uOR) and independent t-test analysis, respectively. Univariate and multivariate logistic regression analysis was performed to obtain adjusted odds ratio (aOR), controlled for patient comorbidities. Results: A total of 165,006 (pVAD 3104, IABP 161902) patients with cardiogenic shock following ACS were included. The proportion of demographics and baseline comorbidities for pVAD vs. IABP were significantly different between the two groups, including age (65 vs. 63 years, p=<0.001, female (33.6% and 27.9%, p=<0.001), caucasian (77.8% vs 72.8%, p=<0.001), respectively. The undusted odds for In-hospital mortality (41.2% vs 29.6%%, uOR, 1.67; 95% CI, 1.55-1.78, P=< 0.001), acute kidney injury (47.6% vs 28.7% uOR, 2.25; 95% CI, 2.09-2.41, P=<0.001) and major bleeding (21% vs 14.8% uOR, 1.54; 95% CI, 1.40-1.68, P=< 0.001) were significantly higher in patients undergoing pVAD compared to IABP. (Figure 1) However, there was no difference in the odds of vascular complications between the two groups (3% vs 2.6%, uOR 1.16; 95% CI, 0.94-1.42, P=0.18. The adjusted odds based on baseline characteristics including hypertension, diabetes, renal failure, anemia, bleeding disorders, age, race and hospital area did not deviate from unadjusted odds ratios. Conclusions: Compared to the IABP, pVAD might have higher odds of in-hospital all-cause mortality, acute kidney injury and major bleeding in ACS induced cardiogenic shock.