Article

A17 - Vascular Complications in Patients with STEMI and Cardiogenic Shock with Percutaneous Mechanical Circulatory Support Devices: Prevalence and Clinical Outcomes from a Large Nationwide Database

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Citation:Interventional Cardiology Review 2019;14(3 Suppl 1):A17.

Correspondence: Omar Chehab, omarshehab1991@gmail.com

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Background: Percutaneous mechanical circulatory support devices (pMCS), such as intra-aortic balloon pump (IABP), percutaneous ventricular assist device (PVAD; Impella or Tandem Heart) and extracorporeal membrane oxygenation (ECMO) are increasingly utilised in patients with ST-elevation MI (STEMI) and cardiogenic shock (STEMI-CS). Large-bore vascular access associated with pMCS may increase bleeding risk and vascular complications. Limited data examining vascular complications with pMCS devices exist.

Hypothesis: We hypothesise an increase in vascular complications with an increase in size of vascular bore access.

Methods: Using the National Inpatient Sample Database, we analysed the prevalence of vascular complications among 35,884 patients with STEMI-CS from 2005 to 2014. We quantified the impact of vascular complications on in-hospital mortality, length of stay (LOS) and healthcare costs.

Results: Among STEMI-CS patients, 338 out of 35,884 (0.9%) had critical limb ischaemia and 6,505 (18.1%) had bleeding complications, including haematomas (4.6%), that required blood transfusions (16.9%) and surgical or endovascular interventions (1.9%). No change in the incidence of vascular complications was noted from 2005 to 2014. The incidence of bleeding complications or acute limb ischaemia was higher among patients with larger-bore pMCS access in the following order: ECMO>PVAD>IABP>no MCS. Mortality rate among patients with bleeding complications and critical limb ischaemia was 27.5% and 35.8%, respectively. Mortality was highest among patients on ECMO who had a bleeding complication (51.0%) or critical limb ischaemia (57.1%). Bleeding complications or critical limb ischaemia were associated with increased LOS and cost of hospitalisation with or without pMCS use. However, inpatient mortality was lower among patients with bleeding complications (27.5% versus 30.8%, p<0.0001).

Conclusion: Vascular complications are common in STEMI-CS requiring pMCS, and are associated with increased LOS and healthcare cost. An increase in the incidence of vascular complications was noted to be highest in patients with ECMO and was also associated with higher inpatient mortality among all devices. New approaches to reduce vascular complications with pMCS in STEMI and CS are required.