Background: Impella (Abiomed) was FDA approved in 2015 for use in high-risk percutaneous coronary intervention (PCI). We compared post-approval outcomes and costs of Impella versus intra-aortic balloon pump (IABP) support for high-risk PCI in real-world contemporary practice in US hospitals.
Methods: From April 2016, to June 2019, 48,179 patients from the Premier Healthcare Database underwent Impella- or IABP-supported PCI at 304 hospitals. We selected patients with nonemergent admission undergoing single PCI procedures with either Impella or IABP support on the day of admission, excluding patients presenting with acute ST-elevation myocardial infarction (STEMI) or cardiogenic shock (CS). Propensity adjustment was used to control baseline differences between treatment groups. Outcomes included in-hospital survival, MI, CS, stroke, bleeding requiring transfusion, acute kidney injury (AKI), index hospitalization length of stay (LOS), and costs.
Results: The 2,156 patients meeting nonemergent high-risk PCI criteria were treated with Impella (n = 1,447) or IABP (n = 709). After propensity adjustment, Impella use was associated with improved survival (odds ratio [OR]: 1.55, 95% confidence interval [CI]: 1.02-2.36) and less MI (OR: 0.29; 95% CI: 0.18-0.46) and CS (OR: 0.54; 95% CI: 0.39-0.74). Stroke, bleeding requiring transfusion, and AKI were similar among groups. Impella use was associated with shortened LOS but increased hospitalization costs versus IABP. In-hospital complications, including MI, CS, stroke, and bleeding requiring transfusion, were strong predictors of death.
Conclusion: In this propensity-adjusted analysis, use of Impella during nonemergent high-risk PCI was associated with improved survival and reduced in-hospital MI and CS versus IABP. Categories: CORONARY: Hemodynamic Support and Cardiogenic Shoc
