Acute cardiac care & resuscitationCohort study
Association of Use of an Intravascular Microaxial Left Ventricular Assist Device vs Intra-aortic Balloon Pump With In-Hospital Mortality and Major Bleeding Among Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock
- Retrospective cohort study
- propensity-matched
- registry-based
Authors' conclusion
Among patients undergoing PCI for AMI complicated by cardiogenic shock from 2015 to 2017, use of an intravascular microaxial LVAD compared with IABP was associated with higher adjusted risk of in-hospital death and major bleeding complications, although study interpretation is limited by the observational design.
Study context
- Population
- Patients undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) complicated by cardiogenic shock, CathPCI and Chest Pain-MI registries (NCDR), October 2015–December 2017
- Participants
- 28,304 patients · 1,680 propensity-matched pairs
- Exposure
- Intravascular microaxial LVAD vs IABP
- Intravascular microaxial LVADn = 1,680
- IABPn = 1,680reference
- Outcome
- In-hospital mortality and in-hospital major bleeding
- Follow-up
- In-hospital
Main finding
In-hospital death
Absolute risk difference
10.9 percentage points
95% CI 7.6–14.2
P < 0.001
By group
Intravascular microaxial LVAD vs IABP
absolute risk difference 10.9 percentage points (95% CI 7.6–14.2); P < 0.001
As reported in the abstract
Observational data: associations, not effects.
Safety
| Outcome | Intravascular microaxial LVAD | IABP | absolute risk difference (percentage points) (95% CI) | P value | |
|---|---|---|---|---|---|
| In-hospital major bleeding (co-primary) · matched cohort | 31.3% | 16.0% | 15.4 (12.5–18.2) | P < 0.001 | |
| −1001020Difference, percentage points (linear scale) |
Original publication
Association of Use of an Intravascular Microaxial Left Ventricular Assist Device vs Intra-aortic Balloon Pump With In-Hospital Mortality and Major Bleeding Among Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock. JAMA. Published 25 February 2020. doi:10.1001/jama.2020.0254
Summarised from the published abstract; every number is checked against it