Association of Mechanical Circulatory Support and Cardiac Catheterization Laboratory Procedural Volumes With Outcomes...

Despite advancements in cardiogenic shock (CS) management, mortality remains high. While hospital volume has been linked to reduced mortality across myriad complex procedures, the cross-volume effects of mechanical circulatory support (MCS) and cardiac catheterization laboratory (CCL) procedures on CS patients not receiving these interventions remain unexplored. Using the 2016 to 2022 Nationwide Readmissions Database, we analyzed nonelective adult CS admissions at MCS- and CCL-capable hospitals. Hospitals were stratified into quartiles by annual volumes of MCS (intra-aortic balloon pump, percutaneous ventricular assist device, extracorporeal membrane oxygenation) and CCL procedures (coronary angiography, percutaneous coronary intervention), with the top quartile classified as high-volume (HVH-MCS or HVHCCL). Multivariable logistic and linear regression models were constructed to evaluate the independent association of high-volume status with mortality, complications, and resource utilization. Among 130,822 CS hospitalizations, 48.2% were treated at HVH-MCS and 46.1% at HVHCCL. Unadjusted mortality was lower at HVH-MCS (24.8% vs 30.7%, p <0.001) and HVHCCL (26.6% vs 29.0%, p <0.001). Following adjustment, HVH-MCS remained associated with reduced mortality (Adjusted odds ratio [AOR] 0.87, 95% confidence interval [CI] 0.82 to 0.93), while HVHCCL showed no significant benefit (p = 0.10). HVH-MCS also had lower respiratory (AOR 0.82, 95% CI 0.78 to 0.86) and infectious (AOR 0.85, 95% CI 0.80 to 0.90) complications, but longer hospital stays (β +1.75 days, 95% CI 1.48 to 2.01) and higher costs (+$8,600, 95% CI 7,100 to 10,100). Increasing MCS volume appears independently correlated with improved CS outcomes, highlighting the cross-volume effect of institutional expertise. Contrastingly, CCL volume was not associated with in-hospital mortality, supporting centralization of CS care at high-volume MCS centers.