THURSDAY, Nov. 21, 2019 (HealthDay News) — Impella use is increasing for percutaneous coronary intervention (PCI) patients treated with mechanical circulatory support (MCS), although its use is associated with adverse events, according to a study published online Nov. 17 in Circulation to coincide with the annual meeting of the American Heart Association, held from Nov. 16 to 18 in Philadelphia.
Amit P. Amin, M.D., from the Washington University School of Medicine in St. Louis, and colleagues describe trends and variations in Impella use among 48,306 patients undergoing PCI with MCS between 2004 and 2016.
The researchers found that 9.9 percent of PCI patients treated with MCS received Impella; use of Impella increased over time and reached 31.9 percent of MCS in 2016. Impella use varied widely across hospitals, with more than a fivefold variation. There was considerable variation in bleeding (>2.5-fold variation), as well as death, acute kidney injury (AKI), and stroke (all ~1.5-fold variation) among Impella patients. Compared with the pre-Impella era, adverse outcomes and costs were higher in the Impella era (2008 to 2016 versus 2004 to 2007). Higher rates of adverse outcomes and costs were seen in hospitals with higher Impella use. Impella use was associated with death, bleeding, and stroke (odds ratios, 1.24 [95 percent confidence interval, 1.13 to 1.36], 1.10 [1.00 to 1.21], and 1.34 [1.18 to 1.53], respectively) after adjustment; a similar, nonsignificant result was seen for AKI (odds ratio, 1.08; 95 percent confidence interval, 1.00 to 1.17).
“These data underscore the need for defining the appropriate use of MCS in patients undergoing PCI with appropriately powered prospective randomized controlled trials,” the authors write.
Several authors disclosed financial ties to the biopharmaceutical, medical device, health insurance, and health care industries.
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