(1509) Mechanical Circulatory Support Devices in Patients With Nonischemic Cardiogenic Shock

Introduction: Mechanical circulatory support (MCS) device use has been extensively evaluated in patients with cardiogenic shock (CS) secondary to acute myocardial infarction. Although non-ischemic CS has a similarly high mortality risk, no large-scale data is available on using MCS devices in this population

Methods: All adult hospitalizations with a diagnosis of non-ischemic cardiomyopathy (NICM) were identified from the Nationwide Inpatient Sample database (2016-2019). Admissions with diagnosis of CS were selected and the use of MCS devices [intraaortic balloon pump (IABP), percutaneous left ventricular assist devices (pLVAD) (Impella/Tandem Heart) and extracorporeal membrane oxygenation (ECMO)] during hospitalization was identified. Hospitalizations with coronary artery disease, right ventricular failure, and cardiac surgery were excluded to remove those developing CS secondary to ischemic cardiomyopathy, right heart disease, or postcardiotomy CS. We analyzed and compared outcomes in hospitalizations with and without MCS device use. Outcomes of interest included in-hospital mortality, hospitalization costs, length of stay, and discharge disposition

Results: During the study period, there were a total of 429,129 admissions with NICM; 13,839 (3.2%) had concomitant CS. Among hospitalizations with nonischemic CS (n=13,839), a total of 1442 (10.4%) admissions received a MCS device with 907 (6.6%) receiving IABP, 443 (3.2%) receiving pLVAD, and 272 (2.0%) receiving ECMO. Hospitalizations receiving an MCS device were significantly younger (50.6±14.6 vs 58.1±16.2, p< 0.001), more often male, and more likely to receive care at large and teaching hospitals when compared to those without an MCS device. Nonischemic CS hospitalizations receiving an MCS device had higher unadjusted and adjusted in-hospital mortality (26% vs. 23.0%; adjusted OR 1.66 [95% CI 1.45-1.90]; p< 0.001). Use of MCS device was associated with significantly longer hospital stay (24.6±26.2 vs 12.9±14.9, p< 0.001), and higher hospitalization charges

Conclusions: In this nationwide study, MCS device was used in only 10.4% of patients with non-ischemic CS and was associated with higher in-hospital mortality and greater resource utilization. More focused investigations on the role of MCS devices in this patient population are essential