C-87 | Outcomes of Bloodless Patients Requiring Mechanical Circulatory Support During Percutaneous Coronary Intervention- A Single Center Retrospective Review

Background: Mechanical circulatory support devices (MCS), including Impella and intra-aortic balloon pumps (IABP), are commonly utilized in managing patients with Acute myocardial infarction complicated by cardiogenic shock (AMIC).However, their impact on mortality and clinical outcomes remains a topic of significant debate.Methods: We conducted a retrospective analysis using the 2020 Nationwide Inpatient Sample (NIS) database to identify patients diagnosed with AMIC who underwent Impella or IABP placement.Patients were stratified into two cohorts: AMIC with Impella and AMIC with IABP.Multivariate logistic regression models were applied to adjust for patient and hospital-level confounders, estimating odds ratios (ORs) for primary and secondary outcomes.The primary outcome was in-hospital mortality.Secondary outcomes included cardiac arrest, cardiac tamponade, stroke, palliative consult (PC), respiratory failure (RF), acute kidney injury, post-procedural bleeding (PPB), length of stay, and total hospital charges.Results: Among 60,184 patients with AMIC, 11,599 underwent MCS with either Impella or IABP.Of these, 5,196 AMIC patients received Impella, and 6,403 AMIC received IABP.The mean age was comparable between groups (66.37 vs. 66.9 years), with males (72.6% vs. 69%) and whites (73.43% vs. 71.4%)predominating.The IABP group demonstrated higher rates of comorbidities, including dyslipidemia, prior MI, previous PCI, hypertension, diabetes, and smoking.In-hospital mortality was observed in 3,735 patients.Multivariate analysis revealed that Impella use was associated with higher odds of in-hospital mortality (OR 2.14, 95% CI 1.81-2.56,P0.0001), RF (OR 1.38, 95% CI 1.12-1.69,P0.002), PPB (OR 3.17, 95% CI 1.92-5.23,P0.000), and PC (OR 1.44, 95% CI 1.09-1.89,P0.008).However, Impella was associated with a reduced risk of sepsis (OR 0.21, 95% CI 0.04-0.99,P0.05).No significant differences were noted in other outcomes.Conclusions: In this large representative cohort of patients with AMIC, Impella use was associated with higher in-hospital mortality and adverse events.These findings stress the importance of tailored decision-making in utilizing MCS devices in this high-risk population.