Comparative Healthcare Resource Utilization of percutaneous mechanical circulatory support using Impella versus intra-aortic balloon pump use for Patients with Acute Coronary syndrome and Cardiogenic Shock Undergoing Percutaneous Coronary Interventions: Insights from National Inpatient Sample.

BACKGROUND: The use of percutaneous mechanical circulatory support (MCS) devices, including Impella and Intra-aortic balloon pump (IABP), in patients with cardiogenic shock has increased in recent times. We aimed to evaluate the impact of the choice of an MCS device on healthcare resource utilization.

METHODS: We queried the National Inpatient Sample registry between October 2016 to December 2018 to identify adults admitted for acute coronary syndrome-related cardiogenic shock and who received percutaneous coronary intervention (PCI). The study population was segregated into Impella and IABP groups using ICD 10 diagnosis codes. The primary endpoint was High healthcare resource utilization (HRU), while secondary outcomes included peri-procedural complications. Propensity scoring matching was used to determine which patients in the Impella cohort had similar health to IABP patients.

RESULTS: During the study period, 439,610 patients were admitted who received hemodynamic support using, Impella or IABP on account of acute coronary syndrome complicated by cardiogenic shock (CS). The median age (years) of the Impella cohort and IABP cohorts were similar (64.1 vs. 65.1, P=0.08). Gender distribution of the Impella CS patients was like IABP patients with female majorities in both groups, (71.9% vs. 67.9%, P=0.05). Impella CS patients had a higher representation of those with hypertension (P=0.002), Smoking (P=0.040), Obesity(P=0.034), Diabetes Mellitus(P=0.009), CHF (P=0.030), COPD(P=0.034), chronic liver disease (P=0.028) and chronic kidney disease(P=0.031). 1:1 Propensity score matching identified 2,620 Impella patients' comparable severity index with the IABP patients. Patients with hemodynamic support using Impella had higher healthcare resource utilization, (HRU), the surrogate of Length of stay (LOS) ≥7 or non-home disposition at discharge, when compared with those with IABP (57.41% vs. 42.76%, P<0.0001). Impella CS patients had higher in-hospital mortality as compared to the IABP patients (55.45% vs 45.86%, P<0.0001). Impella CS patients developed more periprocedural complications, including vascular injury (4.8% vs. 1.4%, P<0.0001), Acute kidney injury (58.36% vs. 41.64%, P<0.0001), end-stage renal disease requiring dialysis (8.75% vs. 1.25%, P=0.002) when compared to the IABP patients.

CONCLUSION: Among patients with ACS undergoing PCI and receiving MCS devices, those receiving Impella demonstrated higher healthcare resource utilization, higher LOS ≥7 days, and more non-home disposition at discharge compared to patients receiving IABP. Further investigation is warranted to elucidate factors associated with these findings.