Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States of America.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America.
PLoS One. 2020 Aug 24;15(8):e0238046. doi: 10.1371/journal.pone.0238046. eCollection 2020.
There are limited data on the complications with a percutaneous left ventricular assist device (pLVAD) vs. intra-aortic balloon pump (IABP) in acute myocardial infarction-cardiogenic shock (AMI-CS).
To assess the trends, rates and predictors of complications.
Using a 17-year AMI-CS population from the National Inpatient Sample, AMI-CS admissions receiving pLVAD and IABP support were evaluated for vascular, lower limb amputation, hematologic, neurologic and acute kidney injury (AKI) complications. In-hospital mortality, hospitalization costs and length of stay in pLVAD and IABP cohorts with complications was studied.
Of 168,645 admissions, 7,855 (4.7%) receiving pLVAD support. The pLVAD cohort had higher comorbidity, cardiac arrest (36.1% vs. 29.7%) and non-cardiac organ failure (74.7% vs. 56.9%) rates. Complications were higher in pLVAD compared to IABP cohort-overall 69.0% vs. 54.7%; vascular 3.8% vs. 2.1%; lower limb amputation 0.3% vs. 0.3%; hematologic 36.0% vs. 27.7%; neurologic 4.9% vs. 3.5% and AKI 55.4% vs. 39.1% (all p<0.001 except for amputation). Non-White race, higher comorbidity, organ failure, and extracorporeal membrane oxygen use were predictors of complications for both cohorts. The pLVAD cohort with complications had higher in-hospital mortality (45.5% vs. 33.1%; adjusted odds ratio 1.65 [95% confidence interval 1.55-1.75]), shorter duration of hospital stay, and higher hospitalization costs compared to the IABP cohort with complications (all p<0.001). These results were consistent in propensity-matched pairs.
AMI-CS admissions receiving pLVAD had higher rates of complications compared to the IABP, with worse in-hospital outcomes in the cohort with complications.
在急性心肌梗死合并心源性休克（AMI-CS）患者中，经皮左心室辅助装置（pLVAD）与主动脉内球囊泵（IABP）相关并发症的数据有限。
评估并发症的趋势、发生率和预测因素。
利用全国住院患者样本中 17 年 AMI-CS 人群，评估接受 pLVAD 和 IABP 支持的 AMI-CS 患者的血管、下肢截肢、血液、神经和急性肾损伤（AKI）并发症。研究 pLVAD 和 IABP 并发症患者的住院死亡率、住院费用和住院时间。
在 168645 例住院患者中，有 7855 例（4.7%）接受了 pLVAD 支持。pLVAD 组的合并症、心脏骤停（36.1% vs. 29.7%）和非心脏器官衰竭（74.7% vs. 56.9%）发生率更高。与 IABP 组相比，pLVAD 组的并发症发生率更高——总体并发症发生率为 69.0% vs. 54.7%；血管并发症发生率为 3.8% vs. 2.1%；下肢截肢发生率为 0.3% vs. 0.3%；血液并发症发生率为 36.0% vs. 27.7%；神经并发症发生率为 4.9% vs. 3.5%；AKI 发生率为 55.4% vs. 39.1%（除了截肢，均为 p<0.001）。非白种人、更高的合并症、器官衰竭和体外膜肺氧合的使用是两个队列并发症的预测因素。与 IABP 组相比，pLVAD 组的并发症患者的住院死亡率更高（45.5% vs. 33.1%；调整后的优势比为 1.65 [95%置信区间为 1.55-1.75]），住院时间更短，住院费用更高（所有 p<0.001）。在倾向匹配的对中，结果一致。
与 IABP 相比，接受 pLVAD 的 AMI-CS 患者的并发症发生率更高，且并发症患者的住院结局更差。
