Percutaneous coronary interventions and hemodynamic support in the USA: A 5 year experience

Nileshkumar J. Patel, Vikas Singh, Samir V. Patel, Chirag Savani, Nilay Patel, Sidakpal Panaich, Shilpkumar Arora, Mauricio G Cohen, Cindy Grines, Apurva O. Badheka

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objectives To compare the utilization and outcomes in patients who had percutaneous coronary interventions (PCIs) performed with intra-aortic balloon pump (IABP) versus percutaneous ventricular assist devices (PVADs) such as Impella and TandemHeart and identify a sub-group of patient population who may derive the most benefit from the use of PVADs over IABP. Background Despite the lack of clear benefit, the use of PVADs has increased substantially in the last decade when compared to IABP. Methods We performed a cross sectional study including using the Nationwide Inpatient Sample. Procedures performed with hemodynamic support were identified through appropriate ICD-9-CM codes. Results We identified 18,094 PCIs performed with hemodynamic support. IABP was the most commonly utilized hemodynamic support device (93%, n = 16, 803) whereas 6% (n = 1069) were performed with PVADs and 1% (n = 222) utilized both IABP and PVAD. Patients in the PVAD group were older in age and had greater burden of co-morbidities whereas IABP group had higher percentage of patients with cardiac arrest. On multivariable analysis, the use of PVAD was a significant predictor of reduced mortality (OR 0.55, 0.36-0.83, P = 0.004). This was particularly evident in sub-group of patients without acute MI or cardiogenic shock. The propensity score matched analysis also showed a significantly lower mortality (9.9% vs 15.1%; OR 0.62, 0.55-0.71, P <0.001) rate associated with PVADs when compared to IABP. Conclusion This largest and the most contemporary study on the use of hemodynamic support demonstrates significantly reduced mortality with PVADs when compared to IABP in patients undergoing PCI. The results are largely driven by the improved outcomes in non-AMI and non-cardiogenic shock patients.

Original languageEnglish (US)
Pages (from-to)563-573
Number of pages11
JournalJournal of Interventional Cardiology
Volume28
Issue number6
DOIs
StatePublished - Dec 1 2015

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Heart-Assist Devices
Percutaneous Coronary Intervention
Hemodynamics
Mortality
Propensity Score
Cardiogenic Shock
International Classification of Diseases
Heart Arrest
Population Groups
Inpatients
Shock
Cross-Sectional Studies
Morbidity
Equipment and Supplies

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Patel, N. J., Singh, V., Patel, S. V., Savani, C., Patel, N., Panaich, S., ... Badheka, A. O. (2015). Percutaneous coronary interventions and hemodynamic support in the USA: A 5 year experience. Journal of Interventional Cardiology, 28(6), 563-573. https://doi.org/10.1111/joic.12254

Percutaneous coronary interventions and hemodynamic support in the USA : A 5 year experience. / Patel, Nileshkumar J.; Singh, Vikas; Patel, Samir V.; Savani, Chirag; Patel, Nilay; Panaich, Sidakpal; Arora, Shilpkumar; Cohen, Mauricio G; Grines, Cindy; Badheka, Apurva O.

In: Journal of Interventional Cardiology, Vol. 28, No. 6, 01.12.2015, p. 563-573.

Research output: Contribution to journalArticle

Patel, NJ, Singh, V, Patel, SV, Savani, C, Patel, N, Panaich, S, Arora, S, Cohen, MG, Grines, C & Badheka, AO 2015, 'Percutaneous coronary interventions and hemodynamic support in the USA: A 5 year experience', Journal of Interventional Cardiology, vol. 28, no. 6, pp. 563-573. https://doi.org/10.1111/joic.12254
Patel, Nileshkumar J. ; Singh, Vikas ; Patel, Samir V. ; Savani, Chirag ; Patel, Nilay ; Panaich, Sidakpal ; Arora, Shilpkumar ; Cohen, Mauricio G ; Grines, Cindy ; Badheka, Apurva O. / Percutaneous coronary interventions and hemodynamic support in the USA : A 5 year experience. In: Journal of Interventional Cardiology. 2015 ; Vol. 28, No. 6. pp. 563-573.
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abstract = "Objectives To compare the utilization and outcomes in patients who had percutaneous coronary interventions (PCIs) performed with intra-aortic balloon pump (IABP) versus percutaneous ventricular assist devices (PVADs) such as Impella and TandemHeart and identify a sub-group of patient population who may derive the most benefit from the use of PVADs over IABP. Background Despite the lack of clear benefit, the use of PVADs has increased substantially in the last decade when compared to IABP. Methods We performed a cross sectional study including using the Nationwide Inpatient Sample. Procedures performed with hemodynamic support were identified through appropriate ICD-9-CM codes. Results We identified 18,094 PCIs performed with hemodynamic support. IABP was the most commonly utilized hemodynamic support device (93{\%}, n = 16, 803) whereas 6{\%} (n = 1069) were performed with PVADs and 1{\%} (n = 222) utilized both IABP and PVAD. Patients in the PVAD group were older in age and had greater burden of co-morbidities whereas IABP group had higher percentage of patients with cardiac arrest. On multivariable analysis, the use of PVAD was a significant predictor of reduced mortality (OR 0.55, 0.36-0.83, P = 0.004). This was particularly evident in sub-group of patients without acute MI or cardiogenic shock. The propensity score matched analysis also showed a significantly lower mortality (9.9{\%} vs 15.1{\%}; OR 0.62, 0.55-0.71, P <0.001) rate associated with PVADs when compared to IABP. Conclusion This largest and the most contemporary study on the use of hemodynamic support demonstrates significantly reduced mortality with PVADs when compared to IABP in patients undergoing PCI. The results are largely driven by the improved outcomes in non-AMI and non-cardiogenic shock patients.",
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AU - Patel, Nileshkumar J.

AU - Singh, Vikas

AU - Patel, Samir V.

AU - Savani, Chirag

AU - Patel, Nilay

AU - Panaich, Sidakpal

AU - Arora, Shilpkumar

AU - Cohen, Mauricio G

AU - Grines, Cindy

AU - Badheka, Apurva O.

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N2 - Objectives To compare the utilization and outcomes in patients who had percutaneous coronary interventions (PCIs) performed with intra-aortic balloon pump (IABP) versus percutaneous ventricular assist devices (PVADs) such as Impella and TandemHeart and identify a sub-group of patient population who may derive the most benefit from the use of PVADs over IABP. Background Despite the lack of clear benefit, the use of PVADs has increased substantially in the last decade when compared to IABP. Methods We performed a cross sectional study including using the Nationwide Inpatient Sample. Procedures performed with hemodynamic support were identified through appropriate ICD-9-CM codes. Results We identified 18,094 PCIs performed with hemodynamic support. IABP was the most commonly utilized hemodynamic support device (93%, n = 16, 803) whereas 6% (n = 1069) were performed with PVADs and 1% (n = 222) utilized both IABP and PVAD. Patients in the PVAD group were older in age and had greater burden of co-morbidities whereas IABP group had higher percentage of patients with cardiac arrest. On multivariable analysis, the use of PVAD was a significant predictor of reduced mortality (OR 0.55, 0.36-0.83, P = 0.004). This was particularly evident in sub-group of patients without acute MI or cardiogenic shock. The propensity score matched analysis also showed a significantly lower mortality (9.9% vs 15.1%; OR 0.62, 0.55-0.71, P <0.001) rate associated with PVADs when compared to IABP. Conclusion This largest and the most contemporary study on the use of hemodynamic support demonstrates significantly reduced mortality with PVADs when compared to IABP in patients undergoing PCI. The results are largely driven by the improved outcomes in non-AMI and non-cardiogenic shock patients.

AB - Objectives To compare the utilization and outcomes in patients who had percutaneous coronary interventions (PCIs) performed with intra-aortic balloon pump (IABP) versus percutaneous ventricular assist devices (PVADs) such as Impella and TandemHeart and identify a sub-group of patient population who may derive the most benefit from the use of PVADs over IABP. Background Despite the lack of clear benefit, the use of PVADs has increased substantially in the last decade when compared to IABP. Methods We performed a cross sectional study including using the Nationwide Inpatient Sample. Procedures performed with hemodynamic support were identified through appropriate ICD-9-CM codes. Results We identified 18,094 PCIs performed with hemodynamic support. IABP was the most commonly utilized hemodynamic support device (93%, n = 16, 803) whereas 6% (n = 1069) were performed with PVADs and 1% (n = 222) utilized both IABP and PVAD. Patients in the PVAD group were older in age and had greater burden of co-morbidities whereas IABP group had higher percentage of patients with cardiac arrest. On multivariable analysis, the use of PVAD was a significant predictor of reduced mortality (OR 0.55, 0.36-0.83, P = 0.004). This was particularly evident in sub-group of patients without acute MI or cardiogenic shock. The propensity score matched analysis also showed a significantly lower mortality (9.9% vs 15.1%; OR 0.62, 0.55-0.71, P <0.001) rate associated with PVADs when compared to IABP. Conclusion This largest and the most contemporary study on the use of hemodynamic support demonstrates significantly reduced mortality with PVADs when compared to IABP in patients undergoing PCI. The results are largely driven by the improved outcomes in non-AMI and non-cardiogenic shock patients.

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