Complications from percutaneous-left ventricular assist devices versus intra-aortic balloon pump in acute myocardial infarction-cardiogenic shock

Saraschandra Vallabhajosyula, V. Subramaniam, Dennis H. Murphree, Sri Harsha Patlolla, Lina Ya’Qoub, Vinayak Kumar, Dhiran Verghese, Wisit Cheungpasitporn, Jacob C. Jentzer, Gurpreet S. Sandhu, Rajiv Gulati, Nilay D. Shah, Bernard J. Gersh, David Holmes, Malcolm R. Bell, Gregory W. Barsness

Research output: Contribution to journalArticle

Abstract

Background 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). Objective To assess the trends, rates and predictors of complications. Methods 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. Results 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. Conclusions AMI-CS admissions receiving pLVAD had higher rates of complications compared to the IABP, with worse in-hospital outcomes in the cohort with complications.

Original languageEnglish (US)
Article numbere0238046
JournalPloS one
Volume15
Issue number8 August
DOIs
StatePublished - Aug 2020

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

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    Vallabhajosyula, S., Subramaniam, V., Murphree, D. H., Patlolla, S. H., Ya’Qoub, L., Kumar, V., Verghese, D., Cheungpasitporn, W., Jentzer, J. C., Sandhu, G. S., Gulati, R., Shah, N. D., Gersh, B. J., Holmes, D., Bell, M. R., & Barsness, G. W. (2020). Complications from percutaneous-left ventricular assist devices versus intra-aortic balloon pump in acute myocardial infarction-cardiogenic shock. PloS one, 15(8 August), [e0238046]. https://doi.org/10.1371/journal.pone.0238046