D-7 | Retrospective Comparison of Impella Versus Left Ventricular Assist Device (LVAD) In Cardiogenic Shock Caused By Myocardial Infarction: Do Females Fare Worse?

Few studies have compared the safety and efficacy of Impella versus LVAD for patients with cardiogenic shock due to myocardial infarction. We compared in-hospital outcomes associated with Impella and LVAD to classify which device would provide superior hemodynamic support in cardiogenic shock in this special population. In a retrospective cohort study of National Inpatient Sample 2017 data, we used ICD-10 codes to identify patients with a primary diagnosis of cardiogenic shock who received Impella or LVAD while hospitalized. Multivariate logistic regression was used to adjust for patient demographics, hospital demographics, and relevant comorbidities. Primary outcomes (inpatient mortality, length of stay) and secondary outcomes (e.g., major bleeding, organ damage) between the LVAD and Impella groups were compared. Among 30,513 patients hospitalized for cardiogenic shock, 1,532 (0.05%) received Impella support, and 707 (0.02%) received LVAD support. Impella use was associated with greater in-hospital mortality (43% vs. 21%, OR 10, p<0.0001). Still, patients on LVAD have longer hospital length of stay (34.7 days vs. 12.6 days, OR 17.9, p<0.0001) and higher inpatient costs ($1,00,600 vs $460,000, OR 15.9, p<0.0001) than Impella support. Furthermore, LVAD patients more frequently had respiratory failure (3.1% vs 2.2%, OR 4.02, p<0.0001), atrial fibrillation (34.7% vs. 22.7%, OR 1.5, p <0.0001), and AKI (59.8% vs 41.9%, OR 3.56, p<0.0001). Females had higher mortality than males (OR 10, p <0.02), Medicaid patients (OR 9.7, p<0.002), and urban non-teaching hospitals (p<0.026), but Native Americans (OR 10.5, p<0.015), urban teaching hospitals (OR 8.8, p<0.048)), and small bed hospitals (OR 12.4, p<0.009) had higher mortality with LVAD compared to Impella support. Previous clinical trials show that patients with Impella and LVAD had similar outcomes, but our results suggest that in patients with cardiogenic shock, patients with Impella support had higher mortality, but there was greater hospital LOS and total hospital charges with LVAD. We also identified that women had a higher mortality in the LVAD group.