Division of Cardiology, Atlanta VA Medical Center, Decatur, GA, United States.
Division of Cardiology, Morehouse School of Medicine, Atlanta, GA, United States.
Am J Med Sci. 2021 Jan;361(1):55-62. doi: 10.1016/j.amjms.2020.08.018. Epub 2020 Aug 12.
Patients suffering an acute myocardial infarction complicated by cardiogenic shock (AMICS) may experience clinical deterioration with concomitant atrial fibrillation (AF). Recent data suggest that percutaneous ventricular assist devices (pVADs) provide superior hemodynamic support over intra-aortic balloon pump (IABP) in AMICS. In patients with AF+AMICS, however, outcomes data comparing these two devices remain limited.
Using the National Inpatient Sample datasets (2008-2014) and a propensity-score matched analysis, we compared the outcomes of AMICS+AF hospitalized patients undergoing PCI with pVAD vs. IABP support.
A total of 12,842 AMICS+AF patients were identified (pVAD=468, IABP=12,374). The matched groups (pVAD=443, IABP=443) were comparable in terms of mean age (70.3 ± 12.0 vs. 70.4 ± 11.0yrs, p = 0.92). The utilization of pVAD was higher in whites but lower in Medicare/Medicaid beneficiaries as compared to IABP. The pVAD group demonstrated higher rates of obesity (13.6% vs. 7.8%, p = 0.006) and dyslipidemia (48.4% vs. 41.8%, p = 0.05). There was no difference in the in-hospital mortality (40.5% vs. 36.8%, p = 0.25); however, pVAD group had a lower incidence of post-procedural MI and higher incidences of stroke (7.8% vs. 4.4%, p = 0.03), hemorrhage (5.6% vs. 2.3%, p = 0.01), discharges to home health care (13.5% vs. 10.1%, p<0.001) and to other facilities (29.1% vs. 24.9%, p<0.001) as compared to IABP group. There was no difference between the groups in terms of mean length of stay or hospital charges.
All-cause inpatient mortality was similar in AMICS+AF patients undergoing PCI who were treated with either pVAD or IABP. The pVAD group, however, experienced more complications while consuming greater healthcare resources.
患有急性心肌梗死合并心源性休克（AMICS）的患者可能会出现临床恶化，同时伴有心房颤动（AF）。最近的数据表明，经皮心室辅助装置（pVAD）在心源性休克合并 AMICS 患者中提供的血流动力学支持优于主动脉内球囊泵（IABP）。然而，在患有 AF+AMICS 的患者中，比较这两种设备的结果数据仍然有限。
我们使用国家住院患者样本数据集（2008-2014 年）和倾向评分匹配分析，比较了接受 PCI 治疗的 AMICS+AF 住院患者使用 pVAD 与 IABP 支持的结果。
共确定了 12842 例 AMICS+AF 患者（pVAD=468，IABP=12374）。在匹配的组中（pVAD=443，IABP=443），平均年龄（70.3±12.0 岁与 70.4±11.0 岁，p=0.92）相当。与 IABP 相比，白人更倾向于使用 pVAD，而医疗保险/医疗补助受益人则较少使用。pVAD 组的肥胖率（13.6%比 7.8%，p=0.006）和血脂异常率（48.4%比 41.8%，p=0.05）较高。住院死亡率无差异（40.5%比 36.8%，p=0.25）；然而，pVAD 组术后心肌梗死发生率较低，而中风发生率较高（7.8%比 4.4%，p=0.03），出血发生率较高（5.6%比 2.3%，p=0.01），出院至家庭保健护理（13.5%比 10.1%，p<0.001）和其他设施（29.1%比 24.9%，p<0.001）的比例较高。与 IABP 组相比，两组的平均住院时间或住院费用无差异。
接受 PCI 治疗的 AMICS+AF 患者，使用 pVAD 或 IABP 的全因住院死亡率相似。然而，pVAD 组经历了更多的并发症，同时消耗了更多的医疗资源。
