C-6 | Comparative Healthcare Resource Utilization of Impella versus Intra-Aortic Balloon Pump Use for Patients With Acute Coronary Syndrome and Cardiogenic Shock Undergoing Percutaneous Coronary Interventions: Insights from National Inpatient Sample

Abstract

The use of percutaneous mechanical circulatory support (MCS) devices, including Impella and Intra-aortic balloon pump (IABP), in patients with cardiogenic shock (CS) has increased in recent times. We aimed to evaluate the impact of the choice of MCS device on healthcare resource utilization. We queried the National Inpatient Sample registry between October 2016 to December 2018 to identify adults admitted for ACS related CS and received percutaneous coronary intervention (PCI). The study population was segregated into Impella and IABP groups using ICD 10 diagnosis codes. Primary endpoint was high healthcare resource utilization (HRU), while secondary outcomes included peri procedural complications. Propensity scoring modelling was used to identify matched pair of Impella and IABP patients, adjusting for severity index, comorbidities. During the study period, 439,610 patients received MCS using, Impella or IABP on account of ACS related CS. Median age (years) of the Impella and IABP patients were similar (64.1 vs. 65.1, P=0.08). Gender distribution of the Impella CS patients were like IABP patients with female majorities in both groups, (71.9% vs. 67.9%, P=0.05). Impella patients had a higher comorbidity burden. 1:1 Propensity score matching identified 2,620 Impella patients comparable severity index with IABP patients. Impella patients had higher HRU, surrogate of length of stay (LOS) >7 or non-home disposition at discharge, compared to IABP patients (94.2% vs. 87.3%, P<0.001). Impella patients had higher in-hospital mortality compared to IABP patients (42.8% vs 26.9%, P<0.001). Impella patients also developed more periprocedural complications, including vascular injury (4.6% vs. 1.9%, P=0.004), acute kidney injury (61.5% vs. 51.9%, P<0.001), acute kidney injury requiring dialysis (5.5% vs. 2.9%, P=0.01) when compared to IABP patients. Among patients with ACS undergoing PCI and receiving MCS devices, those receiving Impella demonstrated greater high healthcare resource utilization, had higher LOS >7 days, and more non-home disposition at discharge compared to patients receiving IABP. Further investigation is warranted to elucidate factors associated with these findings.