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Ungar A, Rivasi G, Testa GD, Boureau AS, Mattace-Raso F, Martínez-Sellés M, Bo M, Petrovic M, Werner N, Benetos A. Geriatricians' role in the management of aortic stenosis in frail older patients: a decade later. Eur Geriatr Med 2024:10.1007/s41999-024-01015-9. [PMID: 39037643 DOI: 10.1007/s41999-024-01015-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 06/25/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION Increasing evidence supports the implementation of geriatric assessment in the workup of older patients with aortic stenosis (AS). In 2012, an online European survey revealed that geriatricians were rarely involved in the assessment of candidates for transcatheter aortic valve implantation (TAVI). After a "call to action" for early involvement of geriatricians in AS evaluation, the survey was repeated in 2022. Our aim was to investigate whether geriatricians' role changed in the last decade. METHODS Online survey conducted between December 16th, 2021, and December 15th, 2022. All members of the European Geriatric Medicine Society were invited to participate. The survey included 26 questions regarding geriatricians' experience with AS and TAVI. RESULTS Among 193 respondents (79.8% geriatricians), 73 (38%) reported to be involved in AS evaluation at least once a week. During 2 years prior to the survey, 43 (22.3%) had referred > 50% of their patients with severe AS for TAVI. Age influenced TAVI referral in a considerable proportion of respondents (36.8%). TAVI candidates were mainly referred to specialised cardiac centres with multidisciplinary teams (91.8%), including (47.2%) or not including (44.6%) a geriatrician. A total of 38.9% of respondents reported to be part of a multidisciplinary heart team. Geriatricians were less frequently involved (37%) than cardiologists (89.6%) and surgeons (53.4%) in pre-procedural TAVI management. Cardiologists were more frequently involved (85.5%) than geriatricians (33.7%) and surgeons (26.9%) in post-procedural management. CONCLUSIONS Geriatricians' involvement in AS management and multidisciplinary heart teams remains scarce. More efforts should be devoted to implement geriatricians' role in AS decision-making.
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Affiliation(s)
- Andrea Ungar
- Geriatrics and Intensive Care Unit, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
| | - Giulia Rivasi
- Geriatrics and Intensive Care Unit, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Giuseppe Dario Testa
- Geriatrics and Intensive Care Unit, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Anne Sophie Boureau
- Nantes Université, CHU Nantes, Pole de Gérontologie Clinique, 44000, Nantes, France
| | - Francesco Mattace-Raso
- Division of Geriatrics, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Manuel Martínez-Sellés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain
| | - Mario Bo
- Section of Geriatric, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza, Molinette, Turin, Italy
| | - Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Nikos Werner
- Heart Center Trier, Department of Internal Medicine III, Krankenhaus der Barmherzigen Brüder Trier, Trier, Germany
| | - Athanase Benetos
- Geriatric Department and Federation Hospital-University On Cardiovascular Aging (FHU-CARTAGE), University Hospital of Nancy, Université de Lorraine, Vandoeuvre-Lès-Nancy, France
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Ismayl M, Ahmed H, Goldsweig AM, Eleid MF, Guerrero M. Economic Disparities in Utilization and Outcomes of Structural Heart Disease Interventions in the United States. JACC. ADVANCES 2024; 3:101034. [PMID: 39130026 PMCID: PMC11312775 DOI: 10.1016/j.jacadv.2024.101034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/26/2024] [Accepted: 05/03/2024] [Indexed: 08/13/2024]
Abstract
Background Disparities in access to care cause negative health consequences for underserved populations. Economic disparities in structural heart disease (SHD) interventions are not well characterized. Objectives The objective of this study was to evaluate economic disparities in the utilization and outcomes of SHD interventions in the United States. Methods We queried the National Inpatient Sample (2016-2020) to examine economic disparities in the utilization, in-hospital outcomes, length of stay, and cost of SHD interventions among patients ≥65 years of age. Outcomes were determined using logistic regression models. Results A total of 401,005 weighted hospitalizations for transcatheter aortic valve replacement, left atrial appendage occlusion, transcatheter mitral valve repair, and transcatheter mitral valve replacement were included. Utilization rates (number of procedures performed per 100,000 hospitalizations) were higher in patients with high income compared with medium and low income for transcatheter aortic valve replacement (559 vs 456 vs 338), left atrial appendage occlusion (148 vs 136 vs 99), transcatheter mitral valve repair (65 vs 54 vs 41), and transcatheter mitral valve replacement (7.7 vs 6.7 vs 1.2) (all P < 0.01). Low- and medium-income patients had distinctive demographic and clinical risk profiles compared with high-income patients. There were no significant differences in the adjusted in-hospital mortality, key complications, or length of stay between high-, medium-, and low-income patients following any of the 4 SHD interventions. High-income patients incurred a modestly higher cost with any of the 4 SHD interventions compared with medium- and low-income patients. Conclusions Economic disparities exist in the utilization of SHD interventions in the United States. Nonetheless, adjusted in-hospital outcomes were comparable among high-, medium-, and low-income patients. Multifaceted implementation strategies are needed to attenuate these utilization disparities.
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Affiliation(s)
- Mahmoud Ismayl
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Hasaan Ahmed
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Andrew M. Goldsweig
- Department of Cardiovascular Medicine, Baystate Medical Center, Springfield, Massachusetts, USA
| | - Mackram F. Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Ismayl M, Ahmed H, Goldsweig AM, Alkhouli M, Prasad A, Guerrero M. Racial/Ethnic, Sex, and Economic Disparities in the Utilization and Outcomes of Intracoronary Imaging. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101936. [PMID: 39132585 PMCID: PMC11308510 DOI: 10.1016/j.jscai.2024.101936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 02/29/2024] [Accepted: 03/12/2024] [Indexed: 08/13/2024]
Abstract
Background Intracoronary imaging-guided percutaneous coronary intervention (PCI) is associated with improved outcomes compared with angiography-guided PCI. Data on racial/ethnic, sex, and economic disparities in the utilization and outcomes of intracoronary imaging in the United States are scarce. Methods We analyzed the National Inpatient Sample (2016-2020) to examine racial/ethnic, sex, and economic differences in the utilization of intracoronary imaging among patients who underwent PCI. Trends, in-hospital mortality, and safety of intracoronary imaging were also assessed. Results Among 2,212,595 weighted hospitalizations for PCI, 204,735 (9.2%) included intracoronary imaging. The utilization rate of intracoronary imaging was similar in Black and Hispanic patients compared with White patients (9.8% vs 10.2% vs 10.0%; P = .68) and lower for women compared with men (10.0% vs 10.3%; P = .01) and for patients with low and medium income compared with high income (9.2% vs 10.0% vs 12.5%; P < .01). In multivariable regression analysis, low and medium income were independently associated with lower intracoronary imaging use compared with high income (both P < .01). From 2016 through 2020, the use of intracoronary imaging in PCI increased significantly in all racial/ethnic, sex, and economic groups (all P trend < .01). Among patients who underwent PCI with intracoronary imaging, Black race was associated with higher odds of acute kidney injury compared with White race (adjusted odds ratio, 1.40; 95% CI, 1.25-1.57). In-hospital mortality was similar between different racial/ethnic, sex, and economic groups. Conclusions Low and medium income are independently associated with lower intracoronary imaging use in PCI compared with high income. Further studies are needed to identify effective strategies to mitigate economic disparities in intracoronary imaging use.
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Affiliation(s)
- Mahmoud Ismayl
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Hasaan Ahmed
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Andrew M. Goldsweig
- Department of Cardiovascular Medicine, Baystate Medical Center, Springfield, Massachusetts
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Abhiram Prasad
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Ismayl M, Ahmed H, Goldsweig AM, Freeman JV, Alkhouli M. In-hospital safety outcomes of left atrial appendage occlusion in octogenarians and nonagenarians. Europace 2024; 26:euae055. [PMID: 38391186 PMCID: PMC10927254 DOI: 10.1093/europace/euae055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 02/20/2024] [Indexed: 02/24/2024] Open
Abstract
AIMS Data on safety outcomes of left atrial appendage occlusion (LAAO) in elderly patients are limited. This study aimed to compare the outcomes of LAAO between octogenarians (age 80-89) and nonagenarians (age ≥90) vs. younger patients (age ≤79). METHODS AND RESULTS We conducted a retrospective cohort study using the National Inpatient Sample database to identify patients hospitalized for LAAO from 2016 to 2020 and to compare in-hospital safety outcomes in octogenarians and nonagenarians vs. younger patients. The primary outcome was a composite of in-hospital all-cause mortality or stroke. Secondary outcomes included procedural complications, length of stay (LOS), and total costs. Outcomes were determined using logistic regression models. Among 84 140 patients hospitalized for LAAO, 32.9% were octogenarians, 2.8% were nonagenarians, and 64.3% were ≤79 years of age. Over the study period, the volume of LAAO increased in all age groups (all Ptrend < 0.01). After adjustment for clinical and demographic factors, octogenarians and nonagenarians had similar odds of in-hospital all-cause mortality or stroke [adjusted odds ratio (aOR) 1.41, 95% confidence interval (CI) 0.93-2.13 for octogenarians; aOR 1.69, 95% CI 0.67-3.92 for nonagenarians], cardiac tamponade, acute kidney injury, major bleeding, and blood transfusion, in addition to similar LOS and total costs compared with younger patients (all P > 0.05). However, octogenarians and nonagenarians had higher odds of vascular complications compared with younger patients (aOR 1.47, 95% CI 1.08-1.99 for octogenarians; aOR 1.60, 95% CI 1.18-2.97 for nonagenarians). CONCLUSION Octogenarians and nonagenarians undergoing LAAO have a similar safety profile compared with clinically similar younger patients except for higher odds of vascular complications.
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Affiliation(s)
- Mahmoud Ismayl
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Hasaan Ahmed
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, NE, USA
| | - Andrew M Goldsweig
- Department of Cardiovascular Medicine, Baystate Medical Center, Springfield, MA, USA
| | - James V Freeman
- Department of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Vora AN, Batchelor WB, Boudoulas KD, Daggubati R, Elmariah S, Hermiller JB, Khalique O, Kliger C, Mahoney PD, Skelding KA, Smith TB, Szerlip M, Goldsweig AM, Church M, Contreras N, Haddad M, Rangwala N, Schleifer D, Schlueter LR, Skelton K. Breaking Down Barriers to Transcatheter Aortic Valve Replacement. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101257. [PMID: 39131785 PMCID: PMC11308245 DOI: 10.1016/j.jscai.2023.101257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/07/2023] [Accepted: 11/22/2023] [Indexed: 08/13/2024]
Affiliation(s)
| | | | | | - Ramesh Daggubati
- West Virginia University School of Medicine, Morgantown, West Virginia
| | - Sammy Elmariah
- University of California – San Francisco, San Francisco, California
| | | | - Omar Khalique
- St. Francis Hospital & Heart Center, Roslyn, New York
| | - Chad Kliger
- Northwell Health Lenox Hill Hospital, New York, New York
| | | | | | | | - Molly Szerlip
- Baylor Scott & White The Heart Hospital – Plano, Plano, Texas
| | - Andrew M. Goldsweig
- University of Massachusetts – Baystate Medical Center, Springfield, Massachusetts
| | - SCAI 2023 Think Tank Structural Consortium
- Yale School of Medicine, New Haven, Connecticut
- Inova Fairfax Hospital, McLean, Virginia
- The Ohio State University Wexner Medical Center, Columbus, Ohio
- West Virginia University School of Medicine, Morgantown, West Virginia
- University of California – San Francisco, San Francisco, California
- Ascension St. Vincent Heart Center, Indianapolis, Indiana
- St. Francis Hospital & Heart Center, Roslyn, New York
- Northwell Health Lenox Hill Hospital, New York, New York
- UPMC Pinnacle, Harrisburg, Pennsylvania
- Confluence Health, Wenatchee, Washington
- Trinity Health System, CommonSpirit Health, Steubenville, Ohio
- Baylor Scott & White The Heart Hospital – Plano, Plano, Texas
- University of Massachusetts – Baystate Medical Center, Springfield, Massachusetts
- Corazon, Pittsburgh, Pennsylvania
- LivaNova, Pittsburgh, Pennsylvania
- Boston Scientific, Maple Grove, Minnesota
- GE Healthcare, Marlborough, Massachusetts
- Edwards Lifesciences, Irvine, California
- Medtronic, Minneapolis, Minnesota
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Madanat L, Allam M, Khalili H, Rabah A, Tariq R, Zamzam M, Rodés-Cabau J, Pilgrim T, Okuno T, Elmariah S, Pibarot P, Abbas AE. Long-Term Survival and Quality of Life Following Transcatheter Aortic Valve Replacement in Nonagenarians. Am J Cardiol 2024; 213:140-145. [PMID: 38134979 DOI: 10.1016/j.amjcard.2023.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/16/2023] [Accepted: 12/17/2023] [Indexed: 12/24/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) has emerged as a successful treatment option for severe aortic stenosis. However, the long-term outcomes of TAVR in nonagenarians is lacking. We aimed to examine the long-term mortality and quality of life in nonagenarians after TAVR. This is a multicenter, retrospective analysis on patients with severe aortic stenosis who underwent TAVR. Patients were divided into 2 groups: nonagenarians (age ≥90 years) and age <90 years. The Kansas City cardiomyopathy questionnaire (KCCQ) and New York Heart Association (NYHA) scores were compared before and after TAVR. All-cause mortality was compared between both groups at 30 days, 1 year, and 5 years after TAVR using the Cox proportional hazard model. A total of 6,896 patients were included, of whom 591 were nonagenarians. Nonagenarians had a higher Society of Thoracic Surgeons perioperative risk of mortality (8.1 ± 4.6% vs 5.4 ± 4.2%, p <0.001) before TAVR. Both groups were similar in KCCQ and NYHA scores at baseline. At 1 year after TAVR, there was no significant difference in improvement in the KCCQ overall score between those aged <90 years and nonagenarians (-4.76, 95% confidence interval [CI] -11.4 to 1.9, p = 0.161). Similarly, there was no statistically significant difference in improvement in NYHA class between the 2 groups at 1 year (odds ratio 1.07, 95% CI 0.85 to 1.25), p = 0.526). The unadjusted 30-day (3.2% vs 2.7%, hazard ratio 1.11, 95% CI 0.70 to 1.80, p = 0.667) and 5-year (28.0% vs 26.6%, hazard ratio 1.05, 95% CI 0.89 to 1.24, p = 0.60) all-cause mortality were similar between the 2 groups. In conclusion, this study demonstrates an excellent long-term mortality rate at 5 years after TAVR in nonagenarians, comparable to patients younger than 90 years. There is a significant and enduring improvement in functional status in nonagenarians, observed up to 1 year after TAVR.
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Affiliation(s)
- Luai Madanat
- William Beaumont University Hospital, Corewell Health East, Michigan
| | - Mohamed Allam
- William Beaumont University Hospital, Corewell Health East, Michigan
| | - Houman Khalili
- Florida Atlantic University, Boca Raton, Florida; Memorial Cardiovascular Institute, Hollywood, Florida
| | - Andrew Rabah
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Rehan Tariq
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Mazen Zamzam
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Josep Rodés-Cabau
- Université Laval, Québec, Canada; Québec Heart and Lung Institute, Québec, Canada
| | | | | | | | - Philippe Pibarot
- Université Laval, Québec, Canada; Québec Heart and Lung Institute, Québec, Canada
| | - Amr E Abbas
- William Beaumont University Hospital, Corewell Health East, Michigan; Oakland University William Beaumont School of Medicine, Rochester, Michigan.
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Ismayl M, Abbasi M, Al-Abcha A, El-Am E, Alkhouli M, Guerrero M, Dispenzieri A, Nkomo VT, Abou Ezzeddine OF, Grogan M, Anavekar NS. Outcomes of transcatheter aortic valve replacement in patients with and without amyloidosis: A nationwide analysis from the United States. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 58:34-42. [PMID: 37468384 DOI: 10.1016/j.carrev.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/18/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Amyloidosis is a common comorbidity in elderly patients with aortic stenosis (AS) referred for transcatheter aortic valve replacement (TAVR). This study aims to assess the impact of amyloidosis on the clinical outcomes of TAVR. METHODS This is a retrospective study of the National Inpatient Sample database that identified adult patients (≥18 years) with AS hospitalized for TAVR from 2016 through 2020 to compare outcomes in those with versus without amyloidosis. Our primary outcome was in-hospital mortality. Secondary outcomes included procedural complications, hospital length of stay (LOS), and total costs. TAVR trends in both cohorts were also evaluated. RESULTS The total cohort included 304,710 patients with AS undergoing TAVR, of whom 410 had amyloidosis. Over the study period, TAVR trends increased significantly in patients with and without amyloidosis (both ptrend < 0.01). Patients with amyloidosis were more likely to be older males with atrial fibrillation/flutter, congestive heart failure, renal disease, and dementia compared to non-amyloidosis patients. After adjustment for baseline characteristics, patients with amyloidosis had similar odds of in-hospital mortality (adjusted odds ratio [aOR] 1.66, 95 % confidence interval [CI] 0.34-3.63), heart block (aOR 1.33, 95 % CI 0.84-2.10), permanent pacemaker insertion (aOR 0.67, 95 % CI 0.27-1.66), stroke (aOR 0.90, 95 % CI 0.32-3.13), acute kidney injury, major bleeding, blood transfusion, vascular complications, in addition to similar LOS (p = 0.21) and total costs (p = 0.18) compared to patients without amyloidosis. CONCLUSION In patients with AS undergoing TAVR, comorbid amyloidosis is associated with similar in-hospital mortality and procedural complications compared to patients without amyloidosis.
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Affiliation(s)
- Mahmoud Ismayl
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA.
| | - Muhannad Abbasi
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Abdullah Al-Abcha
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Edward El-Am
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Angela Dispenzieri
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Omar F Abou Ezzeddine
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Martha Grogan
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Nandan S Anavekar
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA
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Ismayl M, Hussain Y, Aboeata A, Walters RW, Naidu SS, Messenger JC, Basir MB, Rao SV, Goldsweig AM, Altin SE. Pulmonary Artery Catheter Use and Outcomes in Patients With ST-Elevation Myocardial Infarction and Cardiogenic Shock Treated With Impella (a Nationwide Analysis from the United States). Am J Cardiol 2023; 203:304-314. [PMID: 37517125 DOI: 10.1016/j.amjcard.2023.06.117] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/24/2023] [Accepted: 06/29/2023] [Indexed: 08/01/2023]
Abstract
The role of continuous hemodynamic assessment with pulmonary artery (PA) catheter placement in cardiogenic shock (CS) remains debated. We aimed to assess the association between PA catheter placement and clinical outcomes in patients with CS secondary to ST-elevation myocardial infarction (STEMI) treated with an intravascular microaxial flow pump. We identified patients hospitalized with STEMI complicated by CS on mechanical circulatory support with an intravascular microaxial flow pump (Impella, Abiomed, Danvers, Massachusetts) using the National Inpatient Sample database and compared the outcomes in those treated with and without PA catheters. The primary outcome was in-hospital mortality. The secondary outcomes included in-hospital complications, hospital length of stay, inpatient costs, and temporal trends. The total cohort included 14,635 hospitalizations for STEMI complicated by CS treated with Impella between 2016 and 2020, of whom 5,505 (37.6%) received PA catheters. Over the study period, the use of PA catheters increased significantly from 25.9% to 41.8% (ptrend <0.01). Similarly, the use of Impella increased from 9.9% to 18.9% (ptrend <0.01). After adjustment for baseline characteristics using a multivariate logistic regression analysis, PA catheter use was associated with lower in-hospital mortality (adjusted odds ratio 0.80, 95% confidence interval 0.67 to 0.96, p = 0.01) and similar cardiovascular, neurologic, renal, and hematologic complications; length of stay; and inpatient costs compared with no PA catheter use. In conclusion, PA catheter use in patients with STEMI complicated by CS treated with Impella is associated with reduced in-hospital mortality and similar complication rates. Given the mortality benefit, further research is necessary to optimize PA catheter use in patients with STEMI with CS.
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Affiliation(s)
- Mahmoud Ismayl
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota.
| | - Yasin Hussain
- Department of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Ahmed Aboeata
- Department of Cardiovascular Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Ryan W Walters
- Clinical Research and Evaluative Sciences, Creighton University School of Medicine, Omaha, Nebraska
| | - Srihari S Naidu
- Department of Cardiovascular Medicine, Westchester Medical Center and New York Medical College, Valhalla, New York
| | - John C Messenger
- Department of Cardiovascular Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Mir B Basir
- Department of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Sunil V Rao
- Department of Cardiovascular Medicine, NYU Langone Health System, New York, New York
| | - Andrew M Goldsweig
- Department of Cardiovascular Medicine, Baystate Medical Center and University of Massachusetts-Baystate, Springfield, Massachusetts
| | - S Elissa Altin
- Department of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
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