Related Experiment Video
Updated: May 11, 2026
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Safety and Efficacy of Percutaneous Ventricular Assist Device vs Intra-Aortic Balloon Pump in Elective High-Risk
Tayyab Shah1,2, Chantal Holy3, Ali Almedhychy4
1Yale Cardiovascular Research Group, Yale School of Medicine, New Haven, Connecticut.
Insights
Percutaneous ventricular assist device (PVAD) support during high-risk percutaneous coronary intervention (HRPCI) shows better outcomes than intra-aortic balloon pump (IABP) support. PVAD-assisted HRPCI is linked to lower mortality and fewer complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- High-risk percutaneous coronary intervention (HRPCI) often requires mechanical circulatory support.
- Percutaneous ventricular assist devices (PVAD) and intra-aortic balloon pumps (IABP) are commonly used for HRPCI.
- Outcomes comparing PVAD and IABP in HRPCI are not well-defined in large contemporary datasets.
Purpose of the Study:
- To compare the clinical outcomes of PVAD-supported versus IABP-supported HRPCI.
- To evaluate 90-day mortality and major adverse cardiac and cerebrovascular events (MACCE).
- To assess secondary outcomes including cardiogenic shock, acute kidney injury, and length of stay.
Main Methods:
- Retrospective analysis of a large hospital administrative dataset (Premier Healthcare Database) from January 2018 to April 2024.
- Inclusion of patients undergoing HRPCI with PVAD or IABP support, excluding specific high-risk subgroups (e.g., cardiogenic shock, STEMI).
- Variable rate propensity score matching using 87 preprocedural variables to balance patient and provider characteristics.
Main Results:
- PVAD support was associated with significantly lower 90-day mortality (7.9% vs 11.8%) and MACCE (10.3% vs 14.9%) compared to IABP support.
- PVAD-supported patients experienced less postprocedural cardiogenic shock (9.5% vs 23.5%) and acute kidney injury (9.9% vs 15.6%).
- PVAD support resulted in shorter lengths of stay (4.3 vs 5.7 days) and higher rates of home discharge.
Conclusions:
- PVAD-supported HRPCI in non-shock patients may offer improved clinical outcomes compared to IABP support.
- The findings suggest a potential benefit of PVAD over IABP in this patient population.
- Further confirmation through randomized controlled trials is warranted to validate these observational findings.
Background:
This study compares outcomes between percutaneous ventricular assist device (PVAD)-supported and intra-aortic balloon pump (IABP)-supported high-risk percutaneous coronary intervention (HRPCI) in a large-scale, contemporary hospital administrative dataset.
Methods:
Patients undergoing HRPCI supported by PVAD or IABP between January 1, 2018, and April 30, 2024, were identified in the Premier Healthcare Database. Patients were excluded if they had cardiogenic shock and/or STEMI on admission, received mechanical circulatory support and PCI on different days, required emergent procedures, had multiple mechanical circulatory support devices used, or received coronary artery bypass grafting surgery within the same admission. Variable rate propensity score matching was conducted with 87 preprocedural variables including patient demographic characteristics, comorbidities, prior procedures, prior complications, and provider/hospital factors. The primary end point was the 90-day mortality, and secondary end points included major adverse cardiac and cerebrovascular events (defined as death, myocardial infarction, or stroke), new cardiogenic shock, 30-day acute kidney injury, in-hospital blood transfusions, length of stay, and discharge disposition.
Results:
A total of 2416 patients who underwent PVAD-assisted HRPCI and 847 patients who underwent IABP-assisted HRPCI (mean age, 72 ± 10.4 years; 66% women; 19% non-White) were matched with good balance among all matched variables. Compared with those who received IABP support, those who received PVAD support had lower 90-day mortality (7.9% vs 11.8%; P = .01), lower 90-day major adverse cardiac and cerebrovascular events (10.3% vs 14.9%; P < .001), less postprocedural cardiogenic shock (9.5% vs 23.5%; P < .001), and less acute kidney injury (9.9% vs 15.6%; P < .001). PVAD-supported patients had shorter mean lengths of stay (4.3 vs 5.7 days; P < .001) and were more likely to be discharged to home. There were no significant differences in rates of blood transfusions (11.3% vs 10.3%; P = .43) or vascular complications between groups.
Conclusions:
This retrospective observational study suggests that PVAD-supported HRPCI in nonshock patients may be associated with improved clinical outcomes compared with IABP-supported HRPCI; however, future randomized trials are required to confirm this finding.
