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Updated: May 6, 2026
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Percutaneous cardiac assist devices compared with surgical hemodynamic support alternatives: cost-effectiveness in
Brijeshwar Maini1, David Gregory, Dennis J Scotti
1PinnacleHealth, Harrisburg, Pennsylvania.
Insights
Percutaneous cardiac assist device (pVAD) therapy offers a cost-effective, less invasive option for emergent hemodynamic support. This approach demonstrates improved survival rates and reduced costs compared to traditional surgical methods for cardiogenic shock patients.
Area of Science:
- Cardiovascular Medicine
- Medical Devices
- Health Economics
Background:
- Percutaneous cardiac assist devices (pVAD) are cost-effective for high-risk PCI.
- pVAD therapy has been shown to reduce length of stay (LOS) in patients with cardiogenic shock (CS).
Purpose of the Study:
- To evaluate the cost-effectiveness of pVAD therapy versus traditional surgical hemodynamic support in emergent settings.
- To compare outcomes, length of stay, and costs between pVAD and surgical alternatives for CS patients.
Main Methods:
- Analysis of national utilization and outcome data (2010-2011) from MedPAR and state-sponsored databases.
- Comparison of patients with acute myocardial infarction complicated by CS treated with pVAD (n=883) versus surgical alternatives (n=305).
- Inclusion of site-specific data for protocol-guided pVAD therapy (Impella 2.5, n=30).
Main Results:
- pVAD therapy showed greater discharge survival (56% vs. 42%, P < 0.001) than surgical alternatives.
- pVAD was associated with a trend toward reduced LOS (13.2 vs. 17.9 days, P = 0.055) and significantly lower index admission costs ($90,929 vs. $144,257, P < 0.001).
- Site-specific data indicated a survival rate of 60%, 6-day LOS, and $53,850 cost with pVAD therapy.
Conclusions:
- Emergent pVAD therapy is a less invasive, cost-effective alternative to surgical support for CS patients.
- pVAD offers improved outcomes, shorter LOS, and lower costs with a survival benefit.
- pVAD therapy, particularly Impella 2.5, is emerging as a dominant strategy for CS management.
Unlabelled:
This study evaluates the cost-effectiveness of percutaneous cardiac assist device (pVAD) therapy in the emergent setting compared with traditional surgical hemodynamic support alternatives.
Background:
Previous research has demonstrated the cost-effectiveness of pVAD hemodynamic support for patients undergoing high-risk percutaneous coronary intervention. For patients in cardiogenic shock (CS), use of pVAD therapy has been shown to reduce length of stay (LOS).
Methods:
National utilization and outcome data from the 2010-2011 MedPAR and state-sponsored all-payer databases were collected for patients with an acute myocardial infarction complicated by CS who were treated with either a pVAD (n = 883) or with traditional surgical hemodynamic support alternatives (ECMO and extracorporeal VAD) (n = 305).
Results:
Discharge survival was greater with pVADs than with surgical alternatives (56% vs. 42%, P < 0.001) and was achieved with a strong trend toward reduced LOS (13.2 and 17.9 days, respectively, P = 0.055) and a significantly lower cost of the index admission ($90,929 and $144,257, respectively, P < 0.001). Cost-effectiveness analysis based on the national data demonstrated that pVAD achieved improved outcomes at lower cost. Data were also collected for similar patients who underwent protocol-guided pVAD therapy (using Impella 2.5) at PinnacleHealth, between 2009 and 2011 (n = 30). At this site, the survival rate increased to 60%, length of hospitalization was shortened to 6 days, and admission costs were lowered to $53,850 relative to the surgical alternatives strategy.
Conclusions:
For patients in CS requiring emergent hemodynamic support, pVAD therapy offers a less invasive alternative that can be deployed sooner, resulting in better outcomes, shorter LOS, lower costs and with no incremental cost, and a survival benefit when compared with traditional surgical hemodynamic support alternatives. PVAD therapy (and Impella 2.5 in particular) is emerging as a dominant strategy for this challenging patient population.
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