Association of Use of an Intravascular Microaxial Left Ventricular Assist Device vs Intra-aortic Balloon Pump With In-Hospital Mortality and Major Bleeding Among Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock.
| Title: | Association of Use of an Intravascular Microaxial Left Ventricular Assist Device vs Intra-aortic Balloon Pump With In-Hospital Mortality and Major Bleeding Among Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock. |
|---|---|
| Authors: | Dhruva SS; University of California, San Francisco School of Medicine, San Francisco.; Section of Cardiology, Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California.; Ross JS; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.; Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut.; Mortazavi BJ; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.; Department of Computer Science and Engineering, Texas A&M University, College Station.; Center for Remote Health Technologies and Systems, Texas A&M University, College Station.; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.; Hurley NC; Department of Computer Science and Engineering, Texas A&M University, College Station.; Krumholz HM; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut.; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.; Curtis JP; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.; Berkowitz A; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.; Masoudi FA; Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora.; Messenger JC; Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora.; Parzynski CS; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.; Ngufor C; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.; Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.; Girotra S; Division of Cardiovascular Diseases, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City.; Amin AP; Cardiovascular Division, Washington University School of Medicine in St Louis, St Louis, Missouri.; Shah ND; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.; Division of Health Care Policy Research, Mayo Clinic, Rochester, Minnesota.; Desai NR; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut. |
| Source: | JAMA [JAMA] 2020 Feb 25; Vol. 323 (8), pp. 734-745. |
| Publication Type: | Journal Article; Multicenter Study; Observational Study; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, Non-P.H.S. |
| Language: | English |
| Journal Info: | Publisher: American Medical Association Country of Publication: United States NLM ID: 7501160 Publication Model: Print Cited Medium: Internet ISSN: 1538-3598 (Electronic) Linking ISSN: 00987484 NLM ISO Abbreviation: JAMA Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Chicago : American Medical Association, 1960- |
| MeSH Terms: | Hospital Mortality*; Heart-Assist Devices/*adverse effects ; Hemorrhage/*etiology ; Intra-Aortic Balloon Pumping/*adverse effects ; Myocardial Infarction/*mortality ; Shock, Cardiogenic/*mortality; Heart Arrest/epidemiology ; Heart-Assist Devices/statistics & numerical data ; Intra-Aortic Balloon Pumping/mortality ; Intra-Aortic Balloon Pumping/statistics & numerical data ; Myocardial Infarction/complications ; Myocardial Infarction/therapy ; Percutaneous Coronary Intervention/statistics & numerical data ; Registries/statistics & numerical data ; ST Elevation Myocardial Infarction/epidemiology ; Shock, Cardiogenic/etiology ; Shock, Cardiogenic/therapy ; Aged ; Cause of Death ; Extracorporeal Membrane Oxygenation ; Female ; Humans ; Male ; Matched-Pair Analysis ; Middle Aged ; Propensity Score ; Retrospective Studies |
| Abstract: | Importance: Acute myocardial infarction (AMI) complicated by cardiogenic shock is associated with substantial morbidity and mortality. Although intravascular microaxial left ventricular assist devices (LVADs) provide greater hemodynamic support as compared with intra-aortic balloon pumps (IABPs), little is known about clinical outcomes associated with intravascular microaxial LVAD use in clinical practice.; Objective: To examine outcomes among patients undergoing percutaneous coronary intervention (PCI) for AMI complicated by cardiogenic shock treated with mechanical circulatory support (MCS) devices.; Design, Setting, and Participants: A propensity-matched registry-based retrospective cohort study of patients with AMI complicated by cardiogenic shock undergoing PCI between October 1, 2015, and December 31, 2017, who were included in data from hospitals participating in the CathPCI and the Chest Pain-MI registries, both part of the American College of Cardiology's National Cardiovascular Data Registry. Patients receiving an intravascular microaxial LVAD were matched with those receiving IABP on demographics, clinical history, presentation, infarct location, coronary anatomy, and clinical laboratory data, with final follow-up through December 31, 2017.; Exposures: Hemodynamic support, categorized as intravascular microaxial LVAD use only, IABP only, other (such as use of a percutaneous extracorporeal ventricular assist system, extracorporeal membrane oxygenation, or a combination of MCS device use), or medical therapy only.; Main Outcomes and Measures: The primary outcomes were in-hospital mortality and in-hospital major bleeding.; Results: Among 28 304 patients undergoing PCI for AMI complicated by cardiogenic shock, the mean (SD) age was 65.0 (12.6) years, 67.0% were men, 81.3% had an ST-elevation myocardial infarction, and 43.3% had cardiac arrest. Over the study period among patients with AMI, an intravascular microaxial LVAD was used in 6.2% of patients, and IABP was used in 29.9%. Among 1680 propensity-matched pairs, there was a significantly higher risk of in-hospital death associated with use of an intravascular microaxial LVAD (45.0%) vs with an IABP (34.1% [absolute risk difference, 10.9 percentage points {95% CI, 7.6-14.2}; P |
| Comments: | Comment in: JAMA. 2020 Feb 25;323(8):716-718. doi: 10.1001/jama.2019.22382.. (PMID: 32040185); Comment in: JAMA. 2020 Jul 21;324(3):303. doi: 10.1001/jama.2020.7551.. (PMID: 32692381); Comment in: JAMA. 2020 Jul 21;324(3):302-303. doi: 10.1001/jama.2020.7557.. (PMID: 32692382) |
| References: | Circulation. 2020 Jan 28;141(4):273-284. (PMID: 31735078); Am J Cardiol. 2003 Oct 15;92(8):930-5. (PMID: 14556868); Int J Cardiol. 2015 Apr 15;185:256-62. (PMID: 25814213); Circ Cardiovasc Qual Outcomes. 2009 Sep;2(5):491-9. (PMID: 20031882); Ann Intern Med. 2008 Nov 4;149(9):618-26. (PMID: 18981487); N Engl J Med. 2012 Oct 4;367(14):1287-96. (PMID: 22920912); Circulation. 2006 Aug 22;114(8):774-82. (PMID: 16908769); JAMA Intern Med. 2013 Jan 28;173(2):132-9. (PMID: 23266500); JAMA Cardiol. 2016 May 1;1(2):117-8. (PMID: 27437879); Circulation. 2017 Oct 17;136(16):e232-e268. (PMID: 28923988); Open Heart. 2019 May 13;6(1):e000987. (PMID: 31218000); J Am Heart Assoc. 2014 Jan 13;3(1):e000590. (PMID: 24419737); Circ Cardiovasc Qual Outcomes. 2012 Jan;5(1):134-40. (PMID: 22253370); J Am Coll Cardiol. 2017 Jan 24;69(3):278-287. (PMID: 27810347); JAMA Intern Med. 2015 Jun;175(6):941-50. (PMID: 25822170); N Engl J Med. 2008 Sep 25;359(13):1330-42. (PMID: 18815397); Catheter Cardiovasc Interv. 2019 Jul 1;94(1):29-37. (PMID: 31104355); BMC Bioinformatics. 2011 Mar 17;12:77. (PMID: 21414208); Circulation. 2019 Mar 5;139(10):1249-1258. (PMID: 30586755); J Am Coll Cardiol. 2001 Dec;38(7):2114-30. (PMID: 11738323); Circulation. 2015 Sep 29;132(13):1243-51. (PMID: 26286905); J Am Coll Cardiol. 2012 Oct 16;60(16):1484-8. (PMID: 22999725); Am Heart J. 2019 Aug;214:60-68. (PMID: 31176289); J Am Coll Cardiol. 2001 Jun 15;37(8):2240-5. (PMID: 11419906); J Am Coll Cardiol. 2008 Nov 4;52(19):1584-8. (PMID: 19007597); Clin Res Cardiol. 2019 Nov;108(11):1249-1257. (PMID: 30900010) |
| Grant Information: | R03 HS025517 United States HS AHRQ HHS; K12 HL138046 United States HL NHLBI NIH HHS; R56 HL130496 United States HL NHLBI NIH HHS; R01 HL131535 United States HL NHLBI NIH HHS; UL1 TR001863 United States TR NCATS NIH HHS; U01 FD005938 United States FD FDA HHS; KL2 TR000450 United States TR NCATS NIH HHS; KM1 CA156708 United States CA NCI NIH HHS; UL1 TR000448 United States TR NCATS NIH HHS; R01 HS025164 United States HS AHRQ HHS; R01 HS025402 United States HS AHRQ HHS; UL1 TR002345 United States TR NCATS NIH HHS; R01 HS022882 United States HS AHRQ HHS; TL1 TR000449 United States TR NCATS NIH HHS; KL2 TR002346 United States TR NCATS NIH HHS; K12 HS026379 United States HS AHRQ HHS |
| Entry Date(s): | Date Created: 20200211 Date Completed: 20201008 Latest Revision: 20210110 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC7042879 |
| DOI: | 10.1001/jama.2020.0254 |
| PMID: | 32040163 |
| Database: | MEDLINE |
Journal Article; Multicenter Study; Observational Study; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, Non-P.H.S.