Elsevier

American Heart Journal

Volume 168, Issue 3, September 2014, Pages 363-373.e12
American Heart Journal

Clinical Investigation
Interventional Cardiology
Temporal trends in the use of intraaortic balloon pump associated with percutaneous coronary intervention in the United States, 1998-2008

https://doi.org/10.1016/j.ahj.2014.02.015Get rights and content

Background

With conflicting evidence regarding the usefulness of intraaortic balloon pump (IABP), reports of IABP use in the United States have been inconsistent. Our objective was to examine trends in IABP usage in percutaneous coronary intervention (PCI) in the United States and to evaluate the association of IABP use with mortality.

Methods

This is a retrospective, observational study using patient data obtained from the Nationwide Inpatient Sample database from 1998 to 2008. Patients undergoing any PCI (1,552,602 procedures) for a primary diagnosis of symptomatic coronary artery disease and acute coronary syndrome, including non–ST-elevation myocardial infarction and ST-elevation myocardial infarction, were evaluated.

Results

The overall use of IABP significantly decreased during the study period from 0.99% in 1998 to 0.36% in 2008 (univariate and multivariate P for trend < .0001). Patients who received IABP had substantially higher rates of shock compared with those who did not receive IABP (38.09% vs 0.70%; P < .0001), which was associated with markedly higher inhospital mortality rates (20.31% vs 0.72%; P < .0001). However, IABP use significantly decreased in patients with shock (36.5%-13.4%) and acute myocardial infarction (2.23%-0.84%) (univariate and multivariate P for trend for both < .0001). A temporal reduction in all-cause PCI-associated mortality from 1.1% in 1998 to 0.86% in 2008 (univariate and multivariate P for trend < .0001) was also observed.

Conclusions

The utilization of IABP associated with PCI significantly decreased between 1998 and 2008 in the United States, even among patients with acute myocardial infarction and shock.

Section snippets

Data source

We analyzed data provided by The Healthcare Cost and Utilization Project (HCUP),11 which is a family of health care databases that has been gathering a large collection of longitudinal hospital care data in the United States beginning in 1988. The HCUP databases combine the data collection efforts of state data organizations, hospital associations, private data organizations, and federal government to create a national pool of patient-level health care data, allowing researchers to investigate

Trends and patterns in IABP use

The overall IABP use in the United States decreased significantly during the study period from 0.99% in 1998 to 0.36% in 2008 (univariate and multivariate P for trend < .0001; Figure 2). The patients’ baseline characteristics are presented in Table I. The patients who received an IABP did not differ in age or gender compared with the non-IABP group. Compared with the non-IABP group, the IABP group appeared acutely ill with substantially higher percentages of CHF (39.4% vs 11.1%; P < .0001), AMI

Discussion

Through time, with advances in device technology, insertion technique from surgical to percutaneous and increasing operator experience, IABP has been successfully used in a wide variety of clinical settings. Although still globally used in patients with shock, accumulating data from studies have demonstrated variable results in overall use and its impact on patient mortality. To date, there have been no consistent reports on IABP use in the United States. In this large and representative data

Conclusion

Intraaortic balloon pump has traditionally been the most commonly used mechanical assist device in AMI patients complicated by shock. However, clinicians appear to be using it less in this clinical setting. Aims toward early revascularization, improvements in management of AMI from the time of symptom onset to cardiac catheterization laboratory intervention, and better primary and secondary prevention may have contributed to the downward trend in inhospital mortality rates in PCI that we

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    This project was supported in part by the National Center for Advancing Translational Sciences, National Institutes of Health, through grant UL1TR000050, and the Division of Cardiology, University of Illinois, at Chicago.

    The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the paper, and its final contents.

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