In-hospital outcomes of cardiogenic shock patients: A propensity score-matched nationwide comparative analysis between intra-aortic balloon pump and percutaneous ventricular assist devices.

Background: Percutaneous ventricular assist devices (pVAD) and intra-aortic balloon pumps (IABP) are mechanical circulatory support options for patients with cardiogenic shock (CS). While pVADs provide greater hemodynamic support, their impact on mortality and hospital outcomes compared to IABP remains unclear.

Methods: We conducted a propensity score-matched analysis of 65,858 CS admissions from the national inpatient sample (2016-2020), evenly divided between IABP and pVAD groups. Admissions, where ECMO or both IABP and pVAD were used during the same admission, were excluded. The primary outcome was in-hospital mortality. Secondary outcomes included complication rate, length of stay, and total hospitalization costs. Sensitivity analyses were performed using inverse probability of treatment weighting (IPTW), and subgroup analyses were conducted based on the different etiologies of CS.

Results: The overall in-hospital mortality rate in the matched cohort was 34.3 %, with significantly higher mortality in the pVAD group compared to the IABP group (40.7 % vs. 28 %, p < 0.001) (OR = 1.77; 95 % CI [1.71, 1.83]). pVAD use was also associated with higher odds of acute kidney injury, ventricular arrhythmia, ischemic stroke, and major bleeding, access site complications like arterial thrombosis and aneurysms. Although the pVAD group had a marginally shorter length of stay, hospitalization costs were higher.

Conclusions: In this nationwide cohort, pVAD use was associated with higher in-hospital mortality, increased complication rates, and higher costs compared to IABP. These findings suggest that while pVADs may offer advanced support, they are linked to substantial risks and costs, warranting careful patient selection.