Temporal Trends in Utilization of Right-Sided Heart Catheterization Among Percutaneous Ventricular Assist Device Recipients in Acute Myocardial Infarction Complicated by Cardiogenic Shock

Authors

• Nikhil Nalluri, Cardiovascular Division, Department of Medicine, Lenox Hill Heart and Vascular Institute, New York City, New York.
• Nileshkumar J. Patel, Cardiovascular Division, Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York City, New York. Electronic address: dr.nilesh.j.patel@gmail.com.
• Varunsiri Atti, Department of Medicine, Michigan State University-Sparrow Hospital, East Lansing, Michigan.
• Varun Kumar, Cardiovascular Division, Department of Medicine, Mt Sinai St Luke's Roosevelt, New York City, New York.
• Mir B. Basir, Cardiovascular Division, Department of Medicine, Henry Ford Health System, Detroit, Michigan.
• William W. O'Neill, Cardiovascular Division, Department of Medicine, Henry Ford Health System, Detroit, Michigan.

Document Type

Article

Abstract

Percutaneous ventricular assist devices (PVAD) have been used at an increasing rate in patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS). Recent evidence has demonstrated that use of invasive hemodynamic monitoring with right-sided heart catheterization (RHC) was associated with improved survival in recipients of PVAD in AMI-CS. We sought to examine the utilization of RHC in patients receiving PVAD in AMI-CS. We queried the Nationwide Inpatient Sample database from 2008 to 2014 and identified patients using ICD-9-CM codes for AMI-CS (410, 785.51), PVAD (37.68), and RHC (37.21, 37.23). Temporal trends were analyzed using Cochrane Armitage test. In 5,925 patients who were treated with PVAD for AMI-CS, 1,691 (28.5%) underwent RHC. The mean (SD) age was 63.9 (12.3) years; majority were males (72.8%) and white (63.3%). Patients receiving RHC had higher baseline burden of co-morbidities, Charlson Co-morbidity Index ≥2 (56.1%). From 2008 to 2014, there was decrease in the utilization of RHC in patients receiving PVAD from 40.4% to 29.8% (p = 0.0005). Mortality decreased in patients who received RHC (56% to 42.6%, p = 0.005), whereas mortality increased in patients without RHC (44.4% to 48.4%, p = 0.001). In conclusion, in patients who present with AMI-CS and were treated with PVAD, there was a progressive decline in the utilization of RHC, despite a temporal decrease in mortality in patients receiving RHC. Novel strategies should be explored to increase the use of RHC in this high-risk patient population.

Medical Subject Headings

Cardiac Catheterization (trends); Female; Follow-Up Studies; Heart Ventricles (physiopathology); Heart-Assist Devices (trends); Hemodynamics (physiology); Humans; Male; Middle Aged; Monitoring, Physiologic (methods); Myocardial Infarction (complications, physiopathology, surgery); Retrospective Studies; Shock, Cardiogenic (etiology, physiopathology, surgery); Time Factors; Treatment Outcome

Publication Date

12-15-2018

Publication Title

The American journal of cardiology

E-ISSN

1879-1913

Volume

122

Issue

12

First Page

2014

Last Page

2017

PubMed ID

30297267

Digital Object Identifier (DOI)

10.1016/j.amjcard.2018.08.065

Recommended Citation

Nalluri, Nikhil; Patel, Nileshkumar J.; Atti, Varunsiri; Kumar, Varun; Basir, Mir B.; and O'Neill, William W., "Temporal Trends in Utilization of Right-Sided Heart Catheterization Among Percutaneous Ventricular Assist Device Recipients in Acute Myocardial Infarction Complicated by Cardiogenic Shock" (2018). Neurology. 2087.
https://scholar.barrowneuro.org/neurology/2087