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
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
