Comparison of Clinical Outcomes of Intraortic Balloon Pump Versus Impella in Patients with Cardiogenic Shock: A Real-World Analysis

Abstract

Background Benefits of temporary mechanical circulatory support has not been demonstrated successfully in clinical trials despite their increased widespread use in the real-world management of patients with cardiogenic shock (CS). Methods Using the Nationwide Readmissions Database from Jan 2016 to Nov 2017, we identified all patients admitted with CS requiring either only intra-aortic balloon pump (IABP) or Impella device implantation (IM) with 30-day follow up. Patients with combined devices or undergoing medical management only were excluded. Propensity matched (1:1) was performed based on demographics and comorbidities to compare the survival, complications, and use of advanced heart failure therapies. Results Out of a total of 236156 patients, 32850(13.9%) had IABP and 8389(3.5%; unweighted n= 4504) patients had IM implantation. Well-matched 4411-pairs of matched IABP vs IM patients had mean similar age (65 vs 64.9 years), women (29.2% vs 28.6%), and acute myocardial infarction (75.7% vs 75.8%). In terms of therapy, no differences in use of right heart catheterization/pulmonary catheter placement or vasopressor use(p>0.05 for all). IM group had higher mortality (45.8% vs. 28.6%, p Conclusion Significant number of CS patients undergo IM implantations with widely different survival as well as candidacy for a heart transplant. The underlying patient- and physician-related differences need to further be explored prior to widespread use of this powerful technology.