TCT-573 Illness Severity Among Patients Undergoing Percutaneous Ventricular Assist Device Versus Intra-Aortic Balloon Pump Supported High-Risk Percutaneous Coronary Intervention (HRPCI)
Recommended Citation
Shah T, Holy C, Moses J, Parise H, Lemor A, O’Neill W, Lansky A. TCT-573 Illness Severity Among Patients Undergoing Percutaneous Ventricular Assist Device Versus Intra-Aortic Balloon Pump Supported High-Risk Percutaneous Coronary Intervention (HRPCI). J Am Coll Cardiol 2024; 84(18):B209.
Document Type
Conference Proceeding
Publication Date
10-29-2024
Publication Title
J Am Coll Cardiol
Abstract
Background: This study was conducted to identify differences between Impella percutaneous ventricular assist device (PVAD) vs intra-aortic balloon pump (IABP)-supported HRPCI cohorts that may confound observational studies comparing the safety and efficacy of these devices. Methods: Patients undergoing HRPCI supported by PVAD or IABP between 2018 and 2024 were identified in the Premier Healthcare Database. Patients were excluded if they had cardiogenic shock or STEMI on admission, required emergent procedures, had multiple mechanical circulatory support devices used, or underwent coronary artery bypass grafting within the same admission. Variable rate propensity score matching was performed using logistic regression analysis with 87 preprocedural variables (identified by statistical importance) including patient demographics, comorbidities, prior procedures, prior complications and provider/hospital factors. Measured covariates among unmatched patients were compared using standard mean difference (SMD) (with values >0.1 suggesting imbalance). Results: In total, we identified 4,879 patients (3,925 PVAD and 954 IABP) who met inclusion criteria. After matching, 1,414 PVAD and 75 IABP patients were excluded. Among excluded patients, PVAD-supported patients were considerably sicker than IABP-supported patients with more pulmonary disease (20.9% vs 10.7%, SMD = 0.283), peripheral vascular disease (35.9% vs 18.7%, SMD = 0.393), valvular disease (43.1% vs 18.7%, SMD = 0.549), and chronic kidney disease (28.2% vs 13.3%, SMD = 0.373). Excluded PVAD patients were also more likely to undergo more complex procedures with higher rates of 3-vessel percutaneous coronary intervention (16.1% vs 5.3%, SMD = 0.352) and atherectomy. Conclusion: Patients undergoing PVAD- vs IABP-assisted HRPCI are substantially sicker, leading to poor overlap in the propensity scores among these populations. This study demonstrates an inherent limitation of propensity matching in observational studies in this population that may bias any potential benefit of PVAD to the null given that a substantial portion of the sickest patients who receive PVAD, who are the most likely to derive benefit, are excluded and less sick patients who may do equally well with IABP are disproportionately included. Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP).
Volume
84
Issue
18
First Page
B209
