Outcomes of Percutaneous Coronary Intervention Requiring Mechanical Circulatory Support in High Risk Patients without Cardiogenic Shock.

Background:
The utilization of mechanical circulatory support (MCS) for percutaneous coronary intervention (PCI) using percutaneous ventricular assist device (PVAD) or intra-aortic balloon pump (IABP) has been increasing. We sought to evaluate the outcome of high-risk coronary intervention using PVAD compared with IABP in non-cardiogenic shock patients.

Methods:
Using the National Inpatient Sampling (NIS) database from 2005-2014, we identified patients who underwent PCI using ICD 9 codes. Patients with cardiogenic shock, acute coronary syndrome or acute myocardial infarction were excluded. Multivariate logistic regression was performed to study high-risk PCI outcome using PVAD compared with IABP.

Results:
Out of 21,848 patients who underwent high-risk PCI requiring MCS, 17,270 (79.0%) patients received IABP and 4,578 (21%) patients received PVAD. PVAD patients were older (69 vs 67, P < 0.001), were less likely to be women (23.3% vs. 33.3%, P < 0.001), and had higher rates of hypertension, diabetes, chronic lung disease, and peripheral vascular disease compared with IABP group (p ≤ 0.007). Using Multivariate logistic regression, PVAD patients had lower in-hospital mortality (6.1% vs 8.8%, aOR 0.64; 95% CI 0.55, 0.75, P < 0.001), vascular complications (4.3% vs. 7.5%, aOR 0.59; 95% CI 0.50, 0.71, P < 0.001), cardiac complications (5.6% vs. 14.5%, aOR 0.35; 95% CI 0.30, 0.41, P < 0.001), and respiratory complications (3.8% vs. 9.8%, aOR 0.36; 95% CI 0.30, 0.43, P < 0.001) compared with patients who received IABP.

Conclusions:
Despite higher comorbidities, high-risk PCI procedures using PVAD were associated with lower mortality compared with IABP.