Acute cardiac care & resuscitationCohort study
The Evolving Landscape of Impella Use in the United States Among Patients Undergoing Percutaneous Coronary Intervention With Mechanical Circulatory Support
- Retrospective cohort study
- propensity-adjusted hierarchical models
- 432 US hospitals
Authors' conclusion
Although unmeasured confounding cannot be ruled out, when analyzed by time periods, or at the hospital level or the patient level, Impella use was associated with higher rates of adverse events and costs.
Study context
- Population
- Patients undergoing percutaneous coronary intervention (PCI) with mechanical circulatory support (MCS) (Impella or intra-aortic balloon pump), Premier Healthcare Database, US, 2004–2016
- Participants
- 48,306 patients · 432 hospitals
- Exposure
- Impella vs intra-aortic balloon pump in patients undergoing PCI with MCS
- Impellan = 4,782
- Outcome
- Trends and variations in Impella use; in-hospital mortality, bleeding requiring transfusion, AKI, stroke, length of stay, hospital costs
Main finding
As reported in the abstract
Impella use among PCI with MCS
| Group | Value | Share of MCS in 2016 |
|---|---|---|
| Impella | 9.9% | 31.9% |
- Variation in Impella use across hospitals
- >5-fold variation
Observational data: associations, not effects.
Further findings
Outcome variation across hospitals among Impella recipients
- Bleeding
- >2.5-fold variation
- Death, AKI and stroke
- ≈1.5-fold variation
Impella era (2008-2016) vs pre-Impella era (2004-2007); hospital level
- Adverse outcomes and costs higher in the Impella era
- Hospitals with higher Impella use had higher rates of adverse outcomes and costs
Safety
| Outcome | OR (95% CI) | |
|---|---|---|
| In-hospital adverse outcomes, patient level — Impella vs Intra-aortic balloon pump · death | 1.24 (1.13–1.36) | |
| In-hospital adverse outcomes, patient level — Impella vs Intra-aortic balloon pump · bleeding | 1.10 (1.00–1.21) | |
| In-hospital adverse outcomes, patient level — Impella vs Intra-aortic balloon pump · stroke | 1.34 (1.18–1.53) | |
| In-hospital adverse outcomes, patient level — Impella vs Intra-aortic balloon pump · AKI, nonsignificant | 1.08 (1.00–1.17) | |
| 0.512Odds ratio (log scale) |
- In-hospital adverse outcomes, patient level: propensity-score adjusted, accounting for clustering by hospital
Original publication
The Evolving Landscape of Impella Use in the United States Among Patients Undergoing Percutaneous Coronary Intervention With Mechanical Circulatory Support. Circulation. Published 17 November 2019. doi:10.1161/circulationaha.119.044007
Summarised from the published abstract; every number is checked against it