TCT-278 Interhospital Variation in Mechanical Circulatory Support Use for Acute Myocardial Infarction Complicated by Cardiogenic Shock
Recommended Citation
Jabri A, Alhuneafat L, Al-Abdouh A, Mhanna M, Abdelhai O, Fang J, Alameh A, Giustino G, Kado H, Madder R, Villablanca P. TCT-278 Interhospital Variation in Mechanical Circulatory Support Use for Acute Myocardial Infarction Complicated by Cardiogenic Shock. J Am Coll Cardiol 2025; 86(17 Supplement):B123.
Document Type
Conference Proceeding
Publication Date
10-28-2025
Publication Title
J Am Coll Cardiol
Keywords
acute heart infarction, aged, assisted circulation, cardiogenic shock, cohort analysis, conference abstract, controlled study, extracorporeal oxygenation, female, heart arrest, hemodynamics, hospital readmission, hospitalization, human, intraaortic balloon pump, left ventricular assist device, length of stay, male, mortality, retrospective study, risk assessment, standardization, surgery, ventricular assist device
Abstract
Background: Cardiogenic shock (CS) complicates acute myocardial infarction (AMI) and carries high mortality. Despite guidelines, selection between intra-aortic balloon pump (IABP) and percutaneous ventricular assist devices (PVAD) lacks standardization, potentially driving institutional practice variation. Methods: Using the 2019 Nationwide Readmissions Database, we analyzed 53,903 non-elective AMI-CS hospitalizations. Hierarchical regression quantified interhospital variation in IABP/PVAD use. Hospitals were stratified into high-IABP or high-PVAD (top decile of risk-adjusted use). Outcomes included escalation to ECMO/LVAD, length of stay (LOS), and costs. Results: Overall, 23.4% received IABP and 12.5% received PVAD. After risk adjustment, 13% (95% CI 11–14%) of IABP and 18% (15–20%) of PVAD variation was attributable to hospital-level differences. High-PVAD hospitals had higher PCI volume (median 257 vs. 204 cases/year, p=0.032) and were more often safety-net institutions (27.4% vs. 11.3%, p=0.023) than high-IABP hospitals. Patients at high-PVAD hospitals had lower adjusted risk of escalation to ECMO (RR 0.53; 95% CI 0.30–0.95) and LVAD (RR 0.28; 0.08–0.94). LOS (−0.16 days; −1.82 to 1.49) and costs ($3,500; −$16,600 to $9,600) did not differ between hospital types. Conclusion: Significant interhospital variation exists in IABP/PVAD utilization for AMI-CS, driven partly by institutional factors like PCI volume and safety-net status. While escalation to advanced support was less frequent at PVAD-preferring centers, resource utilization was comparable. These findings highlight the need for evidence-based protocols to standardize MCS selection. Categories: CORONARY: Hemodynamic Support, Cardiogenic Shock and Cardiac Arrest
Volume
86
Issue
17 Supplement
First Page
B123
