LVAD use in patients undergoing PCI in MI with CS tied to worse outcomes compared to IABP

A heart attack is a medical emergency. A heart attack usually occurs when a blood clot blocks blood flow to the heart. Without blood, tissue loses oxygen and dies.

Intravascular micro axial left ventricular assist device (LVAD) compared with an intra-aortic balloon pump (IABP) has been associated with an increased risk of mortality and bleeding among patients with acute myocardial infarction (AMI) and cardiogenic shock (CS) undergoing percutaneous coronary intervention (PCI). However, evidence on the association of device therapy with a broader array of clinical outcomes, including data on long-term outcomes and cost, is limited.

A study examined the association between intravascular left ventricular assist device or IABP use and clinical outcomes and cost in patients with acute myocardial infarction complicated by cardiogenic shock. This retrospective propensity-matched cohort study used administrative claims data for commercially insured patients from 14 states across the US. Patients included in the analysis underwent PCI for acute myocardial infarction complicated by cardiogenic shock from January 1, 2015, to April 30, 2020. Data analysis was performed from April to November 2021.

The primary outcomes were mortality, stroke, severe bleeding, repeat revascularisation, kidney replacement therapy (KRT), and total health care costs during the index admission. Clinical outcomes and costs were also assessed at 30 days and 1 year.

Results:

• Among 3077 patients undergoing left ventricular assist device for acute myocardial infarction complicated by cardiogenic shock, the mean (SD) age was 65.2 (12.5) years, and 986 (32.0%) had a cardiac arrest.
• Among 817 propensity-matched pairs, intravascular left ventricular assist device use was associated with significantly higher in-hospital, 30-day, and 1-year mortality compared with IABP.
• At 30 days, intravascular left ventricular assist device use was associated with significantly higher bleeding, and mean cost.
• At 1 year, the association of intravascular left ventricular assist device use with bleeding, KRT, and mean cost persisted.

Thus, in this propensity-matched analysis of patients undergoing left ventricular assist device for acute myocardial infarction complicated by cardiogenic shock, intravascular left ventricular assist device use was associated with increased short-term and 1-year risk of mortality, bleeding, KRT, and cost compared with IABP. There is an urgent need for additional evidence surrounding the optimal management of patients with acute myocardial infarction complicated by cardiogenic shock.

Reference:

Miller PE, Bromfield SG, Ma Q, Crawford G, Whitney J, DeVries A, Desai NR. Clinical Outcomes and Cost Associated With an Intravascular Microaxial Left Ventricular Assist Device vs Intra-aortic Balloon Pump in Patients Presenting With Acute Myocardial Infarction Complicated by Cardiogenic Shock. JAMA Intern Med. 2022 Jul 18. doi: 10.1001/jamainternmed.2022.2735. Epub ahead of print. PMID: 35849410.