Rates and impact of vascular complications in mechanical circulatory support
© 2022 Wiley Periodicals LLC..
BACKGROUND: Mechanical circulatory support (MCS) devices are increasingly used for hemodynamic support in cardiogenic shock or high-risk percutaneous coronary interventions. Vascular complications remain a major source of morbidity and mortality despite technological advances with percutaneous techniques. Little is known about the rates and predictors of vascular complications with large-bore access MCS in the contemporary era.
METHODS: The study cohort was derived from National Inpatient Sample using data from 2015 to 2019 for cardiac hospitalizations with the use of: intra-aortic balloon pump (IABP) Impella, and/or extracorporeal membrane oxygenation (ECMO). The rates of vascular complications and in-hospital outcomes were analyzed using multivariable logistic regression.
RESULTS: Of 221,700 hospitalizations with MCS use, the majority had only IABP (68%). The rates of vascular complications were greatest with ECMO (15.8%) when compared with IABP (3.0%) and Impella (5.6%). Among patients with vascular complications, in-hospital mortality was higher with ECMO (56.3%) when compared with IABP (26.2%) and Impella (33.8%). Peripheral arterial disease (PAD) was the strongest predictor of vascular complications, with 10 times higher odds when present (adjusted odds ratio [aOR] 10.96, p < 0.001). In risk-adjusted models, when compared with IABP, the use of Impella (aOR: 1.73, p < 0.001), ECMO (aOR: 5.35, p < 0.001), or a combination of MCS devices (aOR: 3.47, p < 0.001) was associated with higher odds of vascular complications.
CONCLUSIONS: In contemporary practice, the use of MCS is associated with significant vascular complications and in-hospital mortality. Predictors of vascular complications include larger arteriotomy size, female gender, and peripheral arterial disease. Vascular access management remains essential to prevent major complications.
| Errataetall: |
CommentIn: Catheter Cardiovasc Interv. 2022 Apr;99(5):1712-1713. - PMID 35476281 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:99 |
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| Enthalten in: |
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions - 99(2022), 5 vom: 16. Apr., Seite 1702-1711 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Lemor, Alejandro [VerfasserIn] |
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| Links: |
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| Themen: |
Journal Article |
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| Anmerkungen: |
Date Completed 29.04.2022 Date Revised 12.05.2022 published: Print-Electronic CommentIn: Catheter Cardiovasc Interv. 2022 Apr;99(5):1712-1713. - PMID 35476281 Citation Status MEDLINE |
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| doi: |
10.1002/ccd.30150 |
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| Förderinstitution / Projekttitel: |
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NLM337971560 |
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| 245 | 1 | 0 | |a Rates and impact of vascular complications in mechanical circulatory support |
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| 500 | |a CommentIn: Catheter Cardiovasc Interv. 2022 Apr;99(5):1712-1713. - PMID 35476281 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2022 Wiley Periodicals LLC. | ||
| 520 | |a BACKGROUND: Mechanical circulatory support (MCS) devices are increasingly used for hemodynamic support in cardiogenic shock or high-risk percutaneous coronary interventions. Vascular complications remain a major source of morbidity and mortality despite technological advances with percutaneous techniques. Little is known about the rates and predictors of vascular complications with large-bore access MCS in the contemporary era | ||
| 520 | |a METHODS: The study cohort was derived from National Inpatient Sample using data from 2015 to 2019 for cardiac hospitalizations with the use of: intra-aortic balloon pump (IABP) Impella, and/or extracorporeal membrane oxygenation (ECMO). The rates of vascular complications and in-hospital outcomes were analyzed using multivariable logistic regression | ||
| 520 | |a RESULTS: Of 221,700 hospitalizations with MCS use, the majority had only IABP (68%). The rates of vascular complications were greatest with ECMO (15.8%) when compared with IABP (3.0%) and Impella (5.6%). Among patients with vascular complications, in-hospital mortality was higher with ECMO (56.3%) when compared with IABP (26.2%) and Impella (33.8%). Peripheral arterial disease (PAD) was the strongest predictor of vascular complications, with 10 times higher odds when present (adjusted odds ratio [aOR] 10.96, p < 0.001). In risk-adjusted models, when compared with IABP, the use of Impella (aOR: 1.73, p < 0.001), ECMO (aOR: 5.35, p < 0.001), or a combination of MCS devices (aOR: 3.47, p < 0.001) was associated with higher odds of vascular complications | ||
| 520 | |a CONCLUSIONS: In contemporary practice, the use of MCS is associated with significant vascular complications and in-hospital mortality. Predictors of vascular complications include larger arteriotomy size, female gender, and peripheral arterial disease. Vascular access management remains essential to prevent major complications | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a large-bore access | |
| 650 | 4 | |a mechanical circulatory support | |
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| 700 | 1 | |a Dabbagh, Mohammed F |e verfasserin |4 aut | |
| 700 | 1 | |a Cohen, David |e verfasserin |4 aut | |
| 700 | 1 | |a Villablanca, Pedro |e verfasserin |4 aut | |
| 700 | 1 | |a Tehrani, Behnam |e verfasserin |4 aut | |
| 700 | 1 | |a Alaswad, Khaldoon |e verfasserin |4 aut | |
| 700 | 1 | |a Alqarqaz, Mohammad |e verfasserin |4 aut | |
| 700 | 1 | |a Lasorda, David |e verfasserin |4 aut | |
| 700 | 1 | |a Kaki, Amir |e verfasserin |4 aut | |
| 700 | 1 | |a Genereux, Philippe |e verfasserin |4 aut | |
| 700 | 1 | |a O'Neill, William |e verfasserin |4 aut | |
| 700 | 1 | |a Basir, Mir B |e verfasserin |4 aut | |
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