Use of mechanical circulatory support in patients undergoing percutaneous coronary intervention: insights from the National Cardiovascular Data Registry

Amneet Sandhu, Lisa A. McCoy, Smita I. Negi, Irfan Hameed, Prashant Atri, Subhi J. Al'Aref, Jeptha Curtis, Ed McNulty, H. Vernon Anderson, Adhir Shroff, Mark A. Menegus, Rajesh V. Swaminathan, Hitinder Gurm, John Messenger, Tracy Wang, Steven M. Bradley

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

BACKGROUND: Little is known about the contemporary use of intra-aortic balloon pump (IABP) and other mechanical circulatory support (O-MCS) devices in patients undergoing percutaneous coronary intervention (PCI) in the setting of cardiogenic shock.

METHODS AND RESULTS: We identified 76 474 patients who underwent PCI in the setting of cardiogenic shock at one of 1429 National Cardiovascular Data Registry CathPCI participating hospitals from 2009 to 2013. Temporal trends and hospital-level variation in the use of IABP and O-MCS were evaluated. No mechanical circulatory support was used in 41 286 (54%) patients, 29 730 (39%) received IABP only, 2711 (3.5%) received O-MCS only, and 2747 (3.6%) received both IABP and O-MCS. At the start of the study period, 45% of patients undergoing PCI in the setting of cardiogenic shock received an IABP and 6.7% received O-MCS. The proportion of patients receiving IABP declined at an average rate of 0.3% per quarter, whereas the rate of O-MCS use was unchanged over the study period. The predicted probability of IABP use varied significantly by site (hospital median 42%, interquartile range 33% to 51%, range 8% to 85%). The probability of O-MCS use was 20% in less than one-tenth of hospitals.

CONCLUSIONS: In this large national registry, the use of IABP in the setting of PCI for cardiogenic shock decreased over time without a concurrent increase in O-MCS use. The probability of IABP and O-MCS use varied across hospitals, and the use of O-MCS was clustered at a small number of hospitals.

Original languageEnglish (US)
Pages (from-to)1243-1251
Number of pages9
JournalCirculation
Volume132
Issue number13
DOIs
StatePublished - Sep 29 2015

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Percutaneous Coronary Intervention
Registries
Cardiogenic Shock
Equipment and Supplies

Keywords

  • advanced cardiac life support
  • high-risk percutaneous coronary intervention
  • intra-aortic balloon pump
  • percutaneous coronary intervention
  • shock, cardiogenic

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Use of mechanical circulatory support in patients undergoing percutaneous coronary intervention : insights from the National Cardiovascular Data Registry. / Sandhu, Amneet; McCoy, Lisa A.; Negi, Smita I.; Hameed, Irfan; Atri, Prashant; Al'Aref, Subhi J.; Curtis, Jeptha; McNulty, Ed; Anderson, H. Vernon; Shroff, Adhir; Menegus, Mark A.; Swaminathan, Rajesh V.; Gurm, Hitinder; Messenger, John; Wang, Tracy; Bradley, Steven M.

In: Circulation, Vol. 132, No. 13, 29.09.2015, p. 1243-1251.

Research output: Contribution to journalArticle

Sandhu, A, McCoy, LA, Negi, SI, Hameed, I, Atri, P, Al'Aref, SJ, Curtis, J, McNulty, E, Anderson, HV, Shroff, A, Menegus, MA, Swaminathan, RV, Gurm, H, Messenger, J, Wang, T & Bradley, SM 2015, 'Use of mechanical circulatory support in patients undergoing percutaneous coronary intervention: insights from the National Cardiovascular Data Registry', Circulation, vol. 132, no. 13, pp. 1243-1251. https://doi.org/10.1161/CIRCULATIONAHA.114.014451
Sandhu, Amneet ; McCoy, Lisa A. ; Negi, Smita I. ; Hameed, Irfan ; Atri, Prashant ; Al'Aref, Subhi J. ; Curtis, Jeptha ; McNulty, Ed ; Anderson, H. Vernon ; Shroff, Adhir ; Menegus, Mark A. ; Swaminathan, Rajesh V. ; Gurm, Hitinder ; Messenger, John ; Wang, Tracy ; Bradley, Steven M. / Use of mechanical circulatory support in patients undergoing percutaneous coronary intervention : insights from the National Cardiovascular Data Registry. In: Circulation. 2015 ; Vol. 132, No. 13. pp. 1243-1251.
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abstract = "BACKGROUND: Little is known about the contemporary use of intra-aortic balloon pump (IABP) and other mechanical circulatory support (O-MCS) devices in patients undergoing percutaneous coronary intervention (PCI) in the setting of cardiogenic shock.METHODS AND RESULTS: We identified 76 474 patients who underwent PCI in the setting of cardiogenic shock at one of 1429 National Cardiovascular Data Registry CathPCI participating hospitals from 2009 to 2013. Temporal trends and hospital-level variation in the use of IABP and O-MCS were evaluated. No mechanical circulatory support was used in 41 286 (54{\%}) patients, 29 730 (39{\%}) received IABP only, 2711 (3.5{\%}) received O-MCS only, and 2747 (3.6{\%}) received both IABP and O-MCS. At the start of the study period, 45{\%} of patients undergoing PCI in the setting of cardiogenic shock received an IABP and 6.7{\%} received O-MCS. The proportion of patients receiving IABP declined at an average rate of 0.3{\%} per quarter, whereas the rate of O-MCS use was unchanged over the study period. The predicted probability of IABP use varied significantly by site (hospital median 42{\%}, interquartile range 33{\%} to 51{\%}, range 8{\%} to 85{\%}). The probability of O-MCS use was 20{\%} in less than one-tenth of hospitals.CONCLUSIONS: In this large national registry, the use of IABP in the setting of PCI for cardiogenic shock decreased over time without a concurrent increase in O-MCS use. The probability of IABP and O-MCS use varied across hospitals, and the use of O-MCS was clustered at a small number of hospitals.",
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T1 - Use of mechanical circulatory support in patients undergoing percutaneous coronary intervention

T2 - insights from the National Cardiovascular Data Registry

AU - Sandhu, Amneet

AU - McCoy, Lisa A.

AU - Negi, Smita I.

AU - Hameed, Irfan

AU - Atri, Prashant

AU - Al'Aref, Subhi J.

AU - Curtis, Jeptha

AU - McNulty, Ed

AU - Anderson, H. Vernon

AU - Shroff, Adhir

AU - Menegus, Mark A.

AU - Swaminathan, Rajesh V.

AU - Gurm, Hitinder

AU - Messenger, John

AU - Wang, Tracy

AU - Bradley, Steven M.

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N2 - BACKGROUND: Little is known about the contemporary use of intra-aortic balloon pump (IABP) and other mechanical circulatory support (O-MCS) devices in patients undergoing percutaneous coronary intervention (PCI) in the setting of cardiogenic shock.METHODS AND RESULTS: We identified 76 474 patients who underwent PCI in the setting of cardiogenic shock at one of 1429 National Cardiovascular Data Registry CathPCI participating hospitals from 2009 to 2013. Temporal trends and hospital-level variation in the use of IABP and O-MCS were evaluated. No mechanical circulatory support was used in 41 286 (54%) patients, 29 730 (39%) received IABP only, 2711 (3.5%) received O-MCS only, and 2747 (3.6%) received both IABP and O-MCS. At the start of the study period, 45% of patients undergoing PCI in the setting of cardiogenic shock received an IABP and 6.7% received O-MCS. The proportion of patients receiving IABP declined at an average rate of 0.3% per quarter, whereas the rate of O-MCS use was unchanged over the study period. The predicted probability of IABP use varied significantly by site (hospital median 42%, interquartile range 33% to 51%, range 8% to 85%). The probability of O-MCS use was 20% in less than one-tenth of hospitals.CONCLUSIONS: In this large national registry, the use of IABP in the setting of PCI for cardiogenic shock decreased over time without a concurrent increase in O-MCS use. The probability of IABP and O-MCS use varied across hospitals, and the use of O-MCS was clustered at a small number of hospitals.

AB - BACKGROUND: Little is known about the contemporary use of intra-aortic balloon pump (IABP) and other mechanical circulatory support (O-MCS) devices in patients undergoing percutaneous coronary intervention (PCI) in the setting of cardiogenic shock.METHODS AND RESULTS: We identified 76 474 patients who underwent PCI in the setting of cardiogenic shock at one of 1429 National Cardiovascular Data Registry CathPCI participating hospitals from 2009 to 2013. Temporal trends and hospital-level variation in the use of IABP and O-MCS were evaluated. No mechanical circulatory support was used in 41 286 (54%) patients, 29 730 (39%) received IABP only, 2711 (3.5%) received O-MCS only, and 2747 (3.6%) received both IABP and O-MCS. At the start of the study period, 45% of patients undergoing PCI in the setting of cardiogenic shock received an IABP and 6.7% received O-MCS. The proportion of patients receiving IABP declined at an average rate of 0.3% per quarter, whereas the rate of O-MCS use was unchanged over the study period. The predicted probability of IABP use varied significantly by site (hospital median 42%, interquartile range 33% to 51%, range 8% to 85%). The probability of O-MCS use was 20% in less than one-tenth of hospitals.CONCLUSIONS: In this large national registry, the use of IABP in the setting of PCI for cardiogenic shock decreased over time without a concurrent increase in O-MCS use. The probability of IABP and O-MCS use varied across hospitals, and the use of O-MCS was clustered at a small number of hospitals.

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KW - high-risk percutaneous coronary intervention

KW - intra-aortic balloon pump

KW - percutaneous coronary intervention

KW - shock, cardiogenic

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