100.63 In-Hospital Safety and Effectiveness of Non-Emergent, MCS-Supported High-Risk PCI Procedures: A Comprehensive Propensity-Score Matched Analysis of Contemporary, Large-Scale Claims Dataset

Document Type

Conference Proceeding

Publication Date

2-1-2024

Publication Title

JACC Cardiovasc Interv

Abstract

Background: The safety and effectiveness of elective high-risk percutaneous coronary intervention (HRPCI) with microaxial percutaneous ventricular assist device support (v-HRPCI) or intra-aortic balloon pump support (b-HRPCI) are important considerations. Our study compared the safety and effectiveness of v-HRPCI and b-HRPCI in contemporary large-scale dataset. Methods: We identified patients with validated ICD-10 claims in Premier database (2018-22), who had elective v-HRPCI or b-HRPCI in the Premier database between 2018-22. We excluded admissions for right heart failure, cardiogenic shock, STEMI, and CABG procedures concurrent with HRPCI. Propensity score matching (PSM) using logistical regression model was performed on 125 relevant variables to compensate for confounders in history, admission and comorbidities, and pre-existing risks for bleeding. Endpoints included in-hospital (ih) mortality, discharge disposition (home, home health care/HHC, hospice, skilled nursing facility/SNF), length of stay (LOS), hospitalization costs (hosp-$), new-onset in-hospital occurrences of bleeding requiring transfusions (ih-BRT), of kidney failure (ih-KF), of stroke (ih-Strk), and all-cause 30-, and 90-days readmissions (rehosp). Results: After matching, we identified 741 b-HRPCI patients, and 741 v-HRPCI patients. Matching balance was achieved on all 125 variables. In both cohorts, the average age was 71 years, 66% males, ∼60% congestive heart failure, and ∼34% renal failure. The HRPCI was performed on 1-vessel PCI in 49.9% and 71.5% (p<0.001), while 3-vessel PCI performed in 20.8 vs 11.1% (p<0.001), for v-HRPCI and b-HRPCI, respectively. Atherectomy utilization was 8% in v-HRPCI vs 6% in b-HRPCI (p=0.078). The LOS was 4.60±6.75 days vs 6.25±7.74 days (p<0.001), Mortality 7.3% vs 11.1%, (p=0.015), home discharge 70.6% vs 60.1% (p<0.001), SNF 9.4% vs 15.8% (p=0.015), in-hospital BRT was 1.9% vs 1.8% (p=NS), ih-KF was 10.8 vs 17.1 (p=0.001), In-Strk was 1.5 vs 3.1 (p=0.056), for v-HRPCI and b-HRPCI, respectively. Readmission rates were similar for both groups. Conclusions: In the present analysis, when matching contemporary patients for cardiovascular history, risks, the patients undergoing v-HRPCI experienced lower LOS, ih-mortality, SNF, ih-KF, and had higher home discharge rates, compared b-HRPCI. The ih-BRT and ih-Strk, as well as 30-, and 90-day readmission rates were similar between groups.

Volume

17

Issue

4

First Page

S18

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