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Percutaneous Mechanical Circulatory Support for Cardiac Disease: Temporal Trends in Use and Complications Between
Bradley W Ternus, Jacob C Jentzer, Abdallah El Sabbagh
1Mayo Clinic Rochester, 200 First Street SW, Rochester, MN 55905 USA. Barsness.Gregory@mayo.edu.
Insights
Use of percutaneous mechanical circulatory support devices, including intra-aortic balloon pumps (IABP) and Impella, declined before high-risk PCI. Impella devices showed increased complications versus IABPs, with no difference in composite outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Single-access percutaneous mechanical circulatory support (pMCS) devices are used in cardiac interventions.
- Understanding trends and outcomes of pMCS is crucial for clinical practice.
Purpose of the Study:
- To analyze indications, temporal trends, complications, and 1-year outcomes of pMCS device placement.
- To compare outcomes between intra-aortic balloon pumps (IABP) and Impella devices.
Main Methods:
- Retrospective study of 778 patients undergoing pMCS placement (IABP or Impella) from 2009-2015.
- Analysis of device utilization trends, particularly before high-risk percutaneous coronary intervention (PCI).
- Comparison of device-related complications and 1-year composite outcomes.
Main Results:
- Overall pMCS device placement showed no significant yearly trend, but Impella use declined (P=.02).
- Utilization of pMCS before high-risk PCI significantly decreased (P=.04), mainly due to reduced IABP use.
- Device-related complications were higher with Impella (12.5%) than IABP (3.7%; P<.01).
Conclusions:
- A decrease in Impella support and overall pMCS use before high-risk PCI was observed.
- Impella devices were associated with more complications than IABPs.
- No significant difference in 1-year composite outcomes was found between IABP and Impella groups.
Background:
We present the indications for use, temporal trends, complications, and 1-year clinical outcomes after single-access percutaneous mechanical circulatory support device placement from years 2009-2015 at our institution.
Methods And Results:
Patients with an intraaortic balloon pump (IABP) or Impella device placed in the catheterization suite between January 1, 2009 and December 31, 2015 were included. There were a total of 778 patients in this study. The mean number of devices placed per year was 111. There was no statistically significant trend in total number of devices placed overall, but the rate of Impella placement declined over time (P=.02). There was a significant trend toward less use before high-risk percutaneous coronary intervention (PCI) (P=.04). The composite secondary endpoint occurred in 59.4% of patients, with no significant difference between patients treated with an IABP or Impella (P=.66). There were 37 device-related complications, which occurred more commonly with the Impella (12.5%) than with the IABP (3.7%; P<.01).
Conclusions:
There was no significant overall change in the total number of devices placed per year, but we did observe a decreased use of Impella support. There was a significant decrease in the utilization of percutaneous mechanical circulatory support prior to high-risk PCI, driven primarily by a decreased usage of the IABP. There were more complications related to the Impella device vs the IABP, with no improvement in the composite outcome.
