Comparative outcomes of intra-aortic balloon pump versus impella in non-myocardial infarction cardiogenic shock: A National Inpatient Sample Database analysis.

BACKGROUND

Intra-aortic balloon pumps (IABPs) and percutaneous left ventricular assist devices (pLVADs; Impella) are used to stabilize patients with cardiogenic shock (CS). While recent evidence supports their usefulness in myocardial infarction (MI)-related CS, data on non-MI CS, particularly regarding newer Impella models, remain limited. We compared outcomes associated with IABP versus various Impella devices in non-MI CS.

METHODS

We retrospectively analyzed National Inpatient Sample (NIS) data from 2016 to 2022 to identify patients with non-MI CS who received IABP, Impella 2.5/CP, or Impella 5.0/LD/5.5. Outcomes explored were in-hospital mortality, rates of orthotopic heart transplant (OHT) and durable left ventricular assist device (LVAD) implantation, blood transfusion requirements, length of stay, and total hospital charges.

RESULTS

Among patients with non-MI CS, Impella 5.0/LD/5.5 use was associated with lower in-hospital mortality (8.2% vs 14.9%, P=0.006), higher rates of OHT (27.6% vs 11.7%, P<0.001) and LVAD implantation (45.1% vs 15.6%, P<0.001), longer hospital stays (40.4 vs 23.5 d, P<0.001), greater transfusion requirements (21.8% vs 13.5%, P=0.004), and higher total charges ($1350,236 vs $653,962, P<0.001) than IABP. In contrast, Impella 2.5/CP use was associated with greater in-hospital mortality (39.6% vs 23.6%, P<0.001), lower rates of OHT and LVAD implantation, shorter hospital stays (11.2 vs 17.5d, P<0.001), and lower total charges ($416,416 vs $486,318, P<0.001) than IABP.

CONCLUSIONS

In non-MI CS, the high-flow Impella 5.0/LD/5.5, but not the low-flow Impella 2.5/CP, was associated with better survival and higher rates of advanced therapies than IABP, albeit at the expense of greater transfusion requirements, longer hospitalization, and greater resource utilization.