Patel Nileshkumar J, Singh Vikas, Patel Samir V, Savani Chirag, Patel Nilay, Panaich Sidakpal, Arora Shilpkumar, Cohen Mauricio G, Grines Cindy, Badheka Apurva O
Staten Island University Hospital, Staten Island, New York.
University of Miami Miller School of Medicine, Miami, Florida.
J Interv Cardiol. 2015 Dec;28(6):563-73. doi: 10.1111/joic.12254.
To compare the utilization and outcomes in patients who had percutaneous coronary interventions (PCIs) performed with intra-aortic balloon pump (IABP) versus percutaneous ventricular assist devices (PVADs) such as Impella and TandemHeart and identify a sub-group of patient population who may derive the most benefit from the use of PVADs over IABP.
Despite the lack of clear benefit, the use of PVADs has increased substantially in the last decade when compared to IABP.
We performed a cross sectional study including using the Nationwide Inpatient Sample. Procedures performed with hemodynamic support were identified through appropriate ICD-9-CM codes.
We identified 18,094 PCIs performed with hemodynamic support. IABP was the most commonly utilized hemodynamic support device (93%, n = 16, 803) whereas 6% (n = 1069) were performed with PVADs and 1% (n = 222) utilized both IABP and PVAD. Patients in the PVAD group were older in age and had greater burden of co-morbidities whereas IABP group had higher percentage of patients with cardiac arrest. On multivariable analysis, the use of PVAD was a significant predictor of reduced mortality (OR 0.55, 0.36-0.83, P = 0.004). This was particularly evident in sub-group of patients without acute MI or cardiogenic shock. The propensity score matched analysis also showed a significantly lower mortality (9.9% vs 15.1%; OR 0.62, 0.55-0.71, P < 0.001) rate associated with PVADs when compared to IABP.
This largest and the most contemporary study on the use of hemodynamic support demonstrates significantly reduced mortality with PVADs when compared to IABP in patients undergoing PCI. The results are largely driven by the improved outcomes in non-AMI and non-cardiogenic shock patients.
比较接受经皮冠状动脉介入治疗（PCI）时使用主动脉内球囊反搏（IABP）与使用诸如Impella和TandemHeart等经皮心室辅助装置（PVAD）的患者的使用情况及结局，并确定相较于IABP，可能从使用PVAD中获益最大的患者亚组。
尽管缺乏明确益处，但与IABP相比，PVAD在过去十年中的使用显著增加。
我们进行了一项横断面研究，包括使用全国住院患者样本。通过适当的ICD-9-CM编码识别接受血流动力学支持的手术。
我们识别出18,094例接受血流动力学支持的PCI手术。IABP是最常用的血流动力学支持装置（93%，n = 16,803），而6%（n = 1069）使用PVAD进行，1%（n = 222）同时使用IABP和PVAD。PVAD组患者年龄较大且合并症负担较重，而IABP组心脏骤停患者的比例较高。多变量分析显示，使用PVAD是死亡率降低的显著预测因素（OR 0.55，0.36 - 0.83，P = 0.004）。这在无急性心肌梗死或心源性休克的患者亚组中尤为明显。倾向评分匹配分析还显示，与IABP相比，PVAD的死亡率显著更低（9.9%对15.1%；OR 0.62，0.55 - 0.71，P < 0.001）。
这项关于血流动力学支持使用的规模最大且最具时效性的研究表明，在接受PCI的患者中，与IABP相比，PVAD可显著降低死亡率。结果在很大程度上由非急性心肌梗死和非心源性休克患者的结局改善所驱动。
