OR10-1
Clinical Outcomes for Patients with SCAD Complicated by Cardiogenic Shock requiring Impella Support: An Analysis of the National Inpatient Sample
Presenter
Maziyar Daneshvar, DO, Virtua Our Lady of Lourdes Hospital, Philadelphia, PA
Maziyar Daneshvar, DO, Virtua Our Lady of Lourdes Hospital, Philadelphia, PA, Rafail Beshai, DO, Jefferson Health, Sewell, NJ, Kyrillos Girgis, MD, Newark Beth Israel Medical Center, Newark, NJ, Michael Lee, DO, Jefferson Health, Stratford, PA, Tony Elias, MS, Rowansom, Stratford, NJ and Yaser Alhamshari, MBBS, FSCAI, Virtua Our Lady of Lourdes Hospital, Cherry Hill, NJ
Keywords: Cardiogenic Shock and Coronary
Background
: Spontaneous coronary artery dissection (SCAD) is an emergency condition that occurs when a tear forms in the wall of one or more coronary arteries. There is limited data available on the impact of cardiogenic shock requiring Impella on SCAD patients. We sought to examine the national inpatient sample database to describe in-hospital outcomes among these patients.
Methods
: Data were extracted from the National Inpatient Sample (NIS) Database for the years 2019 and 2020. The NIS was searched for hospitalizations of adult SCAD patients with and without a concomitant diagnosis of cardiogenic shock requiring Impella using international classification of diseases 10th revision codes. Multivariate logistic was used to adjust for confounders. The primary outcome was inpatient mortality. Secondary outcomes were hospital length of stay (LOS), and total hospital charges (TOTHCG). SPSS software was used for statistical analysis.
Results
: This study included 5202 SCAD patients, of which 135 (2.59%) patients had cardiogenic shock requiring Impella. SCAD Patients with cardiogenic shock requiring Impella had higher prevalence of hypertension (61.6% Vs. 51.3 %, P< 0.001), diabetes mellitus (32.4% Vs. 21.2%, P< 0.001), and chronic kidney disease (5.9% Vs. 3.1%, P< 0.001). In-hospital mortality was higher among the patients with cardiogenic shock requiring impella (20.1% Vs. 5.0%, P<0.001). Multivariate regression showed that those patients had higher inpatient mortality (OR 2.202, CI 1.928-2.514, P < 0.001) in addition to paying significantly more TOTHCG ($126,997 Vs. $123,410, P < 0.001). The mean LOS was longer among the SCAD patients with cardiogenic shock requiring Impella (14.3 days Vs. 9.1 days, P < 0.001). On secondary analysis it has shown that those patients had higher odds of having intracranial hemorrhage (OR 1.222, CI 1.041-1.435, P < 0.001), acute kidney failure (OR 1.458, CI 1.392-1.526, P < 0.001), and arrhythmias (OR 1.259, CI 1.226-1.294, P < 0.001) compared to SCAD patients without cardiogenic shock.
Conclusions
: In this nationally representative population‐based retrospective cohort study, cardiogenic shock requiring Impella support was associated with higher mortality and worse outcomes among SCAD patients.