Percutaneous Coronary Interventions in Patients Supported with Left Ventricular Assist Devices

Abstract

<h3>Purpose</h3> More than half of patients with advanced heart failure (HF) requiring left ventricular assist device (LVAD) support have severe ischemic cardiomyopathy, yet the incidence, indications, and outcomes of coronary interventions in the LVAD population are unknown. The objective of this study was to describe outcomes of percutaneous coronary interventions (PCI) in LVAD patients. <h3>Methods</h3> Using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS), we identified LVAD patients who underwent diagnostic coronary angiography from 2015-2017. The index admission for LVAD implantation was excluded. Baseline characteristics and in-hospital outcomes of those who underwent PCI vs. diagnostic catheterization only were described. <h3>Results</h3> A total of 33,456 admissions for LVAD patients were identified. Coronary catheterization was performed in 3,830 admissions (11.5%) and 260 of these resulted in PCI (6.8%). Overall, patients were more commonly men (77.3%), white (62.3%), with a high burden of comorbidities based on Elixhauser index ≥3 (99.3%). Acute myocardial infarction (AMI) (83%) was the most common indication for PCI; 35.6% were identified as a ST-elevation MI and 40% presented with or developed cardiogenic shock. Among patients undergoing PCI, the median length-of-stay was 6 days (IQR 4-10) and in-hospital mortality was 15.4%. Among patients undergoing diagnostic catheterization only, the median length-of-stay was 10 days (IQR 5-18) and in-hospital mortality was 4.3%. Other in-hospital outcomes are described in <b>Table 1</b>. <h3>Conclusion</h3> Although PCI procedures are uncommon in LVAD patients, they may be appropriately performed in severe AMI cases. PCI in LVAD patients is associated with significantly high in-hospital mortality. Further studies are warranted to better characterize the risk and outcomes of CAD progression in LVAD patients, as well as the utility of PCI in this complex population.