OR2-8 | Comparing Outcomes Of Intra-Aortic Balloon Pump And Impella In Patients With Cardiogenic Shock Due To Non-ST-Elevation Myocardial Infarction: A Nationwide Retrospective Observational Study

The use of short-term mechanical circulatory assist devices in patients with myocardial infarction complicated with cardiogenic shock has increased in recent years despite a lack of supportive evidence for their survival benefits over medical management. In our study, we compare the in-hospital outcomes between the two such common devices. Data was obtained from the Nationwide Inpatient Sample database from January 2016 to December 2020. The study included all adult patients who had NSTEMI resulting in cardiogenic shock during their hospitalization necessitating either Impella or Intra-Aortic Balloon Pump(IABP) use. The primary outcome was inpatient mortality. Secondary outcomes were cardiac arrest, arrhythmias, acute respiratory failure, and acute renal failure, as well as the need for transfusions, pressors, ventilators, tracheostomy, gastrostomy, and ECMO. Among all adult patients who had NSTEMI resulting in cardiogenic shock, 8,184 patients who had received these mechanical circulatory devices were identified. Among them, 2,082 (25.4%) had impella vs 6,102(74.6%) had IABP. The IABP group was associated with lower in-hospital mortality (24.9% vs 37.3%, aOR: 0.55; 95% CI: 0.49-0.61, p<0.001); when adjusted for age, race, sex, and Charlson comorbidity index. Furthermore, they had a lower risk of cardiac arrest (8.2% vs 11.8%, aOR: 0.64; 95% CI: 0.54-0.76, p< 0.001), ventricular arrhythmias (25.6% vs 32.6%, aOR:0.71; 95% CI: 0.63-0.79, p< 0.001), and acute respiratory failure (58.7% vs 68.2%, aOR: 0.65; 95% CI: 0.58-0.72, p< 0.001). They also required lower life-saving treatments like dialysis (13.1% vs 16.8%, aOR: 0.71; 95% CI: 0.62-0.82, p< 0.001), ventilators (47.6% vs 55.1%, aOR:0.75, 95% CI: 0.68-0.83, p <0.001) and ECMO(3.2% vs 5.6%, aOR:0.58; 95% CI: 0.45-0.74, p <0.001). There was no statistically significant difference in acute renal failure and the need for blood transfusions, pressors, tracheostomy, or gastrostomy. Compared to Impella, our study found that Intra-aortic balloon pumps had significantly better outcomes in patients with NSTEMI who developed cardiogenic shock.