Intra-aortic balloon pump is associated with the lowest whereas Impella with the highest inpatient mortality and complications regardless of severity or hospital types (rural or university) or after adjustment for 47 high risk variables and baseline characteristics by studying over 800,000 inpatients with cardiogenic shock

Abstract

Background: Impella and intra-aortic balloon pumps (IABP) are commonly utilized in patients with cardiogenic shock. However, the effect on mortality remains controversial. The goal of this study was to evaluate the effect of Impella and IABP on mortality and complications in patients with cardiogenic shock. Method: The large Nationwide Inpatient Sample (NIS) database was utilized to study any association between the use of IABP or Impella on mortality and complications in adults with a diagnosis of cardiogenic shocks. Results: ICD-10 codes for Impella, IABP, and cardiogenic shock for available years 2016-2020 were utilized. A total of 844,020 patients had a diagnosis of cardiogenic shock. 101,870 were treated with IABP and 39,645 with an Impella. Total inpatient mortality without any device was 34.2% vs only 25.1% with IABP use (OR=0.65, CI 0.62-0.67) but was highest at 40.7% with Impella utilization (OR=1.32, CI 1.26-1.39). Using multivariate analysis adjusting for 47 variables such as age, gender, race, lactose acidosis, three-vessel intervention, left main myocardial infarction, cardiomyopathy, systolic heart failure, acute ST-elevation myocardial infarction, peripheral vascular disease, chronic renal disease, etc., Impella utilization remained associated with the highest mortality (OR: 1.33, CI 1.25-1.41, p<0.001) whereas IABP remained associated with the lowest mortality (OR: 0.69, CI 0.66-0.72, p<0.001). Separating rural vs teaching hospitals revealed similar findings. Conclusion: In patients with cardiogenic shock, the use of Impella was associated with the highest whereas the utilization of IABP was associated with the lowest in hospital mortality regardless of comorbid condition, high-risk futures, or type of hospital.