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Updated: Sep 10, 2025
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Variation in mechanical circulatory support use for acute myocardial infarction cardiogenic shock
Arjun Verma1,2, Nikhil L Chervu1, Justin J Kim1
1Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Insights
Interhospital variation exists in the use of intra-aortic balloon pumps (IABP) and percutaneous ventricular assist devices (PVAD) for acute myocardial infarction (AMI) with cardiogenic shock (CS). Hospital factors influence device choice, but resource utilization remains similar across centers.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Services Research
Background:
- Cardiogenic shock (CS) following acute myocardial infarction (AMI) is a critical condition with high mortality.
- Mechanical circulatory support, including intra-aortic balloon pumps (IABP) and percutaneous ventricular assist devices (PVAD), is crucial for managing AMI CS.
- Standardized algorithms for IABP and PVAD deployment are lacking, leading to potential variations in care.
Purpose of the Study:
- To evaluate interhospital variations in the utilization of IABP and PVAD for patients with AMI and CS.
- To identify institutional factors associated with a hospital's preference for IABP versus PVAD.
- To assess secondary outcomes such as escalation to other mechanical support, length of stay, and costs.
Main Methods:
- Analysis of the 2019 Nationwide Readmissions Database for adult hospitalizations with AMI and CS.
- Patients were categorized into IABP, PVAD, and non-mechanical circulatory support groups.
- Interhospital variation in device use was quantified, and hospital characteristics (PCI volume, safety net status) were analyzed.
Main Results:
- Of 53,903 patients, 23.4% received IABP and 12.5% received PVAD.
- Center-level differences accounted for approximately 13% of IABP variation and 18% of PVAD variation.
- High-PVAD hospitals had higher PCI volumes and were more likely to be safety net institutions; patients at high-PVAD centers had lower adjusted risks of escalation to ECMO or LVAD implantation.
Conclusions:
- Significant interhospital variation exists in the choice of mechanical circulatory support (IABP vs. PVAD) for AMI CS.
- Hospital characteristics influence device selection, but overall resource utilization (length of stay, costs) was comparable.
- While PVAD use was associated with reduced need for further mechanical support escalation, further research is needed to optimize device selection protocols.
Background:
Cardiogenic shock (CS) is a leading cause of mortality following acute myocardial infarction (AMI). Some patients may require intra-aortic balloon pump (IABP) or percutaneous ventricular assist device (PVAD) placement; however, there is a paucity of standardised algorithms to guide the deployment of each device. The present study evaluated interhospital variation in the use of IABP and PVAD for AMI CS and identified institutional factors associated with hospital-level device preference.
Methods:
All non-elective adult hospitalisations entailing AMI and CS were identified within the 2019 Nationwide Readmissions Database. Patients were grouped into IABP, PVAD and non-mechanical circulatory support cohorts. The primary aim was to quantify the degree of interhospital variation in the use of IABP and PVAD. Escalation to extracorporeal membrane oxygenation (ECMO), left ventricular assist device (LVAD) implantation, length of stay and hospitalisation costs were secondarily assessed. Hospital factors, such as percutaneous coronary intervention (PCI) volume and safety net status, were also analysed.
Results:
Among 53 903 patients, 23.4% received IABP, and 12.5% received PVAD. After adjustment for patient factors, approximately 13% (11-14%) of variation in IABP use and 18% (15-20%) of PVAD use were attributable to centre-level differences. High-PVAD hospitals had higher annual PCI volume (257 (185-369) vs 204 (148-276) cases/year, p=0.032) and were more commonly safety net institutions (27.4% vs 11.3%, p=0.023), compared to high-IABP hospitals. Patients treated at high-IABP and high-PVAD hospitals faced similar length of stay (β -0.16, 95% CI -1.82 to 1.49) and costs (β -$3500, 95% CI -16 600 to 9600). Those at high-PVAD hospitals had lower adjusted risk of escalation to ECMO (0.52, 95% CI 0.29 to 0.95) and LVAD implantation (0.28, 95% CI 0.08 to 0.94).
Conclusions:
The present study identified wide interhospital variation in the use of IABP and PVAD for AMI CS. Although the likelihood of escalation to ECMO or LVAD differed between hospital types, resource utilisation was similar.
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