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Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock
Published on: August 16, 2021
Calcium channel blockers and clinical outcomes in patients with continuous-flow left ventricular assist devices
Hongtao Tie1,2, Zhenhan Li3,4, Henryk Welp1
1Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany.
Insights
Calcium channel blockers (CCBs) do not improve long-term survival in left ventricular assist device (LVAD) patients. CCB use in LVAD recipients was linked to higher risks of neurological issues, bleeding, and rehospitalization.
Area of Science:
- Cardiology
- Medical Devices
- Pharmacology
Background:
- Current guidelines recommend calcium channel blockers (CCBs) as second or third-line therapy for blood pressure management in patients with left ventricular assist devices (LVADs).
- The impact of CCBs on clinical outcomes in LVAD patients remains incompletely understood.
- This study investigates the association between CCB use and patient outcomes post-LVAD implantation.
Purpose of the Study:
- To analyze the association of calcium channel blocker (CCB) therapy with clinical outcomes in patients following left ventricular assist device (LVAD) implantation.
- To evaluate the effect of CCBs on long-term survival and adverse events in the LVAD population.
Main Methods:
- Retrospective analysis of the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) database (2006-2017).
- Inclusion of adult patients alive at 6 months post-LVAD implantation with available CCB treatment data.
- Statistical analyses included Cox and competing risk regressions, time-varying models, and subgroup analyses, adjusting for confounding factors.
Main Results:
- Among 10,717 LVAD patients, 1369 received CCBs at 6 months post-implantation, with an increasing trend in usage.
- CCB therapy at 6 months was not associated with significantly different 5-year survival rates compared to non-CCB users.
- Adjusted analyses (Cox, competing risk, time-varying models) showed no significant association between CCB treatment and long-term mortality.
- Patients on CCBs experienced higher incidences of neurological dysfunction, stroke, bleeding, rehospitalization, and renal dysfunction.
Conclusions:
- Calcium channel blocker (CCB) therapy does not confer survival benefits in patients with left ventricular assist devices (LVADs).
- CCB use in LVAD patients is associated with an increased risk of adverse events, including neurological complications, bleeding, renal dysfunction, and rehospitalization.
- These findings suggest a need to re-evaluate the role of CCBs in the management of LVAD patients.
Aims:
Current guidelines suggest calcium channel blockers (CCBs) as the second or third option for blood pressure management in patients with left ventricular assist device (LVAD). However, the clinical outcomes of patients with LVAD who receive CCBs remain unclear. Our study aims to analyse the association of CCBs with clinical outcomes in patients after LVAD implantation.
Methods And Results:
This is a retrospective analysis based on the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) from 2006 to 2017, and adult patients who were alive with LVAD and CCB treatment information at 6 months after implantation were included. Among 10 717 patients, 1369 received CCBs 6 months after implantation, and there was an increasing trend of CCB use after LVAD. Patients receiving CCB therapy at 6 months had a similar 5 year survival rate to those not receiving CCB [49.6%, 95% confidence interval (CI): 47.5-51.7% vs. 51.1%, 95% CI: 45.3-56.7%]. In both Cox and competing risk regressions after adjusting for confounding factors, CCB treatment at 6 months after implantation was not associated with long-term mortality [hazard ratio (HR): 1.03, 95% CI: 0.91-1.17, P = 0.624 and subdistribution HR (SHR): 1.07, 95% CI: 0.95-1.22, P = 0.260]. Consistently, in time-varying models, CCB treatment was not linked to long-term mortality (HR: 0.97, 95% CI: 0.87-1.09, P = 0.682 and SHR: 1.05, 95% CI: 0.94-1.18, P = 0.359). This null association remained in subgroup analysis according to device strategy and propensity-matching analyses. Neurological dysfunction, stroke, bleeding, rehospitalization, and renal dysfunction were more likely to occur among those with CCB when compared with those without CCB treatment.
Conclusions:
In patients with LVAD, CCB therapy fails to show benefits in long-term survival and is associated with increased incidences of neurological dysfunction, bleeding, renal dysfunction, and rehospitalization.
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