Miller P Elliott, Gordon Aliza S, Liu Ying, Ahmad Tariq, Bromfield Samantha G, Girotra Saket, Davila Carlos D, Crawford Geoffrey, Whitney John, Desai Nihar R
Section of Cardiovascular Medicine Yale School of Medicine New Haven CT USA.
Public Policy Institute, Elevance Health Indianapolis IN USA.
J Am Heart Assoc. 2025 Jan 21;14(2):e037424. doi: 10.1161/JAHA.124.037424. Epub 2025 Jan 10.
The use of mechanical circulatory support devices for high-risk percutaneous coronary intervention (PCI) has increased over the past decade despite limited data of benefit. We sought to examine the association between intravascular microaxial left ventricular assist device (LVAD) versus intra-aortic balloon pump use in patients without cardiogenic shock (CS) undergoing PCI.
This retrospective study analyzed claims data from a large, insured population who underwent PCI without CS from April 1, 2016 to July 31, 2022. Using inverse probability treatment weighting, we assessed for the association between device type and clinical outcomes. The primary outcome was all-cause mortality. Secondary outcomes included stroke, bleeding, incident dialysis, repeat revascularization, and total health care costs during the index admission and at 30 days. We identified 2879 patients without CS who underwent PCI with either an intra-aortic balloon pump or microaxial LVAD. The mean±SD age was 68.2±12.5 years, and 27% (n=764) were women. After propensity weighting, intravascular LVAD use was not associated with a significant difference in either in-hospital (odds ratio [OR] 1.30 [95% CI, 0.88-1.91]; =0.19) or 30-day mortality (OR, 1.19 [95% CI, 0.84-1.69]; =0.33) compared with intra-aortic balloon pump use. Compared with those receiving an intra-aortic balloon pump, the mean total costs for the index admission ($96 716 versus $71 892; <0.001) and at 30 days (+$16 671 [95% CI, $6639-$28 103]; =0.001) were significantly higher in those receiving an intravascular LVAD. There was no significant association between device type and stroke, bleeding, incident dialysis, and repeat revascularization at any time point (all >0.05).
In patients without CS undergoing PCI, intravascular LVAD use was associated with higher costs but not associated with lower mortality. Randomized data are needed to improve device selection for patients without CS undergoing PCI.
尽管获益数据有限，但在过去十年中，用于高风险经皮冠状动脉介入治疗（PCI）的机械循环支持设备的使用有所增加。我们试图研究在未发生心源性休克（CS）的PCI患者中，血管内微轴左心室辅助装置（LVAD）与主动脉内球囊反搏的使用之间的关联。
这项回顾性研究分析了2016年4月1日至2022年7月31日期间接受非CS的PCI的大量参保人群的理赔数据。使用逆概率治疗加权法，我们评估了设备类型与临床结局之间的关联。主要结局是全因死亡率。次要结局包括卒中、出血、开始透析、再次血管重建，以及指数住院期间和30天时的总医疗费用。我们确定了2879例未发生CS且接受主动脉内球囊反搏或微轴LVAD的PCI患者。平均年龄±标准差为68.2±12.5岁，27%（n = 764）为女性。倾向加权后，与使用主动脉内球囊反搏相比，血管内LVAD的使用与住院期间（优势比[OR] 1.30 [95% CI，0.88 - 1.91]；P = 0.19）或30天死亡率（OR，1.19 [95% CI，0.84 - 1.69]；P = 0.33）的显著差异无关。与接受主动脉内球囊反搏的患者相比，接受血管内LVAD的患者指数住院期间的平均总费用（96716美元对71892美元；P < 0.001）和30天时的费用（增加16671美元[95% CI，6639美元 - 28103美元]；P = 0.001）显著更高。在任何时间点，设备类型与卒中、出血、开始透析和再次血管重建之间均无显著关联（均P > 0.05）。
在未发生CS的PCI患者中，血管内LVAD的使用与更高的费用相关，但与更低的死亡率无关。需要随机数据来改善未发生CS的PCI患者的设备选择。
