Key result
In patients without cardiogenic shock undergoing percutaneous coronary intervention, use of an intravascular LVAD compared with an IABP was not associated with a difference in in-hospital mortality but incurred higher healthcare costs.
Why the study?
Mechanical circulatory support device use for high-risk PCI has increased despite limited evidence of benefit, prompting evaluation of intravascular microaxial LVAD versus intra-aortic balloon pump use in patients without cardiogenic shock.
Does intravascular LVAD use improve clinical outcomes or mortality compared to IABP in patients undergoing PCI without cardiogenic shock?
Cohort (n=2,879)
Yes
Does intravascular LVAD use improve clinical outcomes or mortality compared to IABP in patients undergoing PCI without cardiogenic shock?
In PCI patients without cardiogenic shock, using an intravascular LVAD instead of an IABP does not improve short-term mortality but significantly increases healthcare costs.
Answers are grounded in this paper and cite their sources.
Should not yet change practice favoring intravascular LVAD over IABP in PCI without shock; leaves open need for RCTs to assess net benefit.
Background The use of mechanical circulatory support devices for high‐risk percutaneous coronary intervention (PCI) has increased over the past decade despite limited data of benefit. We sought to examine the association between intravascular microaxial left ventricular assist device (LVAD) versus intra‐aortic balloon pump use in patients without cardiogenic shock (CS) undergoing PCI. Methods and Results This retrospective study analyzed claims data from a large, insured population who underwent PCI without CS from April 1, 2016 to July 31, 2022. Using inverse probability treatment weighting, we assessed for the association between device type and clinical outcomes. The primary outcome was all‐cause mortality. Secondary outcomes included stroke, bleeding, incident dialysis, repeat revascularization, and total health care costs during the index admission and at 30 days. We identified 2879 patients without CS who underwent PCI with either an intra‐aortic balloon pump or microaxial LVAD. The mean±SD age was 68.2±12.5 years, and 27% (n=764) were women. After propensity weighting, intravascular LVAD use was not associated with a significant difference in either in‐hospital (odds ratio [OR] 1.30 [95% CI, 0.88–1.91]; P =0.19) or 30‐day mortality (OR, 1.19 [95% CI, 0.84–1.69]; P =0.33) compared with intra‐aortic balloon pump use. Compared with those receiving an intra‐aortic balloon pump, the mean total costs for the index admission ($96 716 versus $71 892; P <0.001) and at 30 days (+$16 671 [95% CI, $6639–$28 103]; P =0.001) were significantly higher in those receiving an intravascular LVAD. There was no significant association between device type and stroke, bleeding, incident dialysis, and repeat revascularization at any time point (all P >0.05). Conclusions In patients without CS undergoing PCI, intravascular LVAD use was associated with higher costs but not associated with lower mortality. Randomized data are needed to improve device selection for patients without CS undergoing PCI.
No takes yet. Share an insight, caveat, or question.
Miller et al. (2025) conducted a cohort in Percutaneous coronary intervention without cardiogenic shock (n=2,879). Intravascular microaxial left ventricular assist device (LVAD) vs. Intra-aortic balloon pump (IABP) was evaluated on In-hospital all-cause mortality (OR 1.30, 95% CI 0.88-1.91, p=0.19). In patients without cardiogenic shock undergoing percutaneous coronary intervention, use of an intravascular LVAD compared with an IABP was not associated with a difference in in-hospital mortality but incurred higher healthcare costs.
Synapse has enriched 10 related papers. Consider them for comparative context: