Trends in the Use of Short-Term Mechanical Circulatory Support in the United States – An Analysis of the 2012 – 2015 National Inpatient Sample

ABSTRACT

Background: We aimed to study the use patterns of short-term mechanical circulatory support (MCS) for cardiogenic shock and associated in-hospital outcomes.

Methods: We queried the National Inpatient Sample from 2012 to 2015 to identify patients with a diagnosis of CS, stratified by presence of acute myocardial infarction (AMI-CS or non-AMI-CS). We then studied trends in the use of short-term MCS. Our primary outcome was in-hospital mortality.

Results: Of 422,575 patients, 44.7% had AMI-CS. From 2012 to 2015, we observed a decrease in use of overall MCS (23.9% to 20.5%, Ptrend < 0.001). The use of intra-aortic balloon pump (21.8% to 16.8%, Ptrend < 0.001) declined, whereas that of percutaneous ventricular assist devices (1.9% to 2.9%, Ptrend < 0.001) and extracorporeal membrane oxygenation/percutaneous cardiopulmonary support (ECMO/PCPS; 1.3% to 2.0%; Ptrend = 0.01) increased. In-hospital mortality of CS remained similar in the overall cohort (38.2% to 38.2%, Ptrend = 0.39) and in the non-AMI-CS (38.8% to 38.3%, Ptrend = 0.53) and AMI-CS cohort (37.6% to 38.1%, Ptrend = 0.46) subgroups.

Conclusion: We observed a decrease in the use of IABP for CS, while the use of pVAD and ECMO/PCPS increased. However, in-hospital mortality remained similar over time in both AMI-CS and non-AMI-CS patients.

KEYWORDS:

• Cardiogenic shock
• STEMI
• Clinical research
• IABP

Disclosure statement

Dr. Deepak L. Bhatt discloses the following relationships – Advisory Board: Cardax, Cereno Scientific, Elsevier Practice Update Cardiology, Medscape Cardiology, PhaseBio, Regado Biosciences; Board of Directors: Boston VA Research Institute, Society of Cardiovascular Patient Care, TobeSoft; Chair: American Heart Association Quality Oversight Committee; Data Monitoring Committees: Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute, for the PORTICO trial, funded by St. Jude Medical, now Abbott), Cleveland Clinic (including for the ExCEED trial, funded by Edwards), Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine (for the ENVISAGE trial, funded by Daiichi Sankyo), Population Health Research Institute; Honoraria: American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org; Vice-Chair, ACC Accreditation Committee), Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute; RE-DUAL PCI clinical trial steering committee funded by Boehringer Ingelheim; AEGIS-II executive committee funded by CSL Behring), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees, including for the PRONOUNCE trial, funded by Ferring Pharmaceuticals), HMP Global (Editor in Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor; Associate Editor), Medtelligence/ReachMD (CME steering committees), Population Health Research Institute (for the COMPASS operations committee, publications committee, steering committee, and USA national co-leader, funded by Bayer), Slack Publications (Chief Medical Editor, Cardiology Today’s Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), WebMD (CME steering committees); Other: Clinical Cardiology (Deputy Editor), NCDR-ACTION Registry Steering Committee (Chair), VA CART Research and Publications Committee (Chair); Research Funding: Abbott, Afimmune, Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Chiesi, CSL Behring, Eisai, Ethicon, Ferring Pharmaceuticals, Forest Laboratories, Idorsia, Ironwood, Ischemix, Lilly, Medtronic, PhaseBio, Pfizer, Regeneron, Roche, Sanofi Aventis, Synaptic, The Medicines Company; Royalties: Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease); Site Co-Investigator: Biotronik, Boston Scientific, St. Jude Medical (now Abbott), Svelte; Trustee: American College of Cardiology; Unfunded Research: FlowCo, Fractyl, Merck, Novo Nordisk, PLx Pharma, Takeda.

None of the other authors report any conflicts of interest.

Supplementary material

Supplementary data for this article can be accessed here.