Trends and Outcomes of Hospitalization of Patients with Ventricular Assist Device Undergoing Percutaneous Coronary Intervention

Background
The use of ventricular assist devices (VAD) has been increasing. However, data about utilization of percutaneous coronary intervention (PCI) in patients with VAD is lacking. We aim to describe the trend and outcomes of PCI in patients with ventricular assist devices (PCI-VAD).

Methods
A descriptive, retrospective study was conducted on the National Inpatient Sample (NIS) database for years 2010-2016. Admissions of patients with VAD were selected based on International Classification of Diseases, Clinical Modification diagnosis codes [Ninth Revision V4321 and Tenth Revision Z95811]. Patients with prior heart transplant (HT) and those who underwent HT during the admission were excluded.

Results
Admissions for patients with LVAD accounted for 103 per million admission(PMA) in 2010, increasing to 456 PMA in 2016 (p<0.001). Among them, 4/1000 LVAD admission underwent PCI in 2010, which increased to 10/1000 LVAD admissions in 2016 (p<0.001). The most common primary admitting diagnosis in PCI-VAD patients were ST-elevation myocardial infarction(STEMI) 65 (34.21%), Non-STEMI (NSTEMI) 50 (26.31%), ventricular tachycardia 10 (5.26%) and acute congestive heart failure 10 (5.26%). Patients with diagnosis of acute myocardial infarction (AMI), the adjusted odds of PCI was significantly lower in those with VAD compared to those without[OR:0.39, CI(0.21-0.76), p=0.005]. The odds of complication of PCI including coronary artery dissection [OR:12.42, CI(2.98-51.88), p=0.001], vascular complication[OR:17.24, CI(2.29-129.37), p=0.006], acute kidney injury[OR:3.09, CI (1.01-9.46), p=0.002] and major bleeding or transfusion[OR:6.23, CI(1.96-19.74), p=0.002] were significantly higher in patients with VAD. However, the adjusted odds of mortality was significantly lower in VAD patients with AMI who underwent PCI[OR:0.014, CI(0.001-0.21), p=0.003].

Conclusions
Patients with VAD presenting with diagnosis of AMI had less PCI performed compared to those without VAD. Complications of PCI were higher in patients with VAD. Regardless, patients with VAD who present with AMI had significantly lower odds of mortality if they undergo PCI compared to those who do not.