Author + information
- Brijeshwar Singh Maini,
- Larisa Buyantseva,
- Kate Acquaviva,
- Aneel Maini,
- Dennis Scotti and
- David Gregory
Previous research has demonstrated the cost–effectiveness of Impella hemodynamic support for patients undergoing high–risk percutaneous coronary intervention. For patients in profound cardiogenic shock (CS), use of Impella therapy has shown promise with regard to mortality and resource consumption metrics such as length of stay (LOS). This study evaluates the cost–effectiveness of Impella percutaneous cardiac assist device (pVAD) therapy in the emergent setting compared with traditional surgical hemodynamic support alternatives.
National utilization and outcome data from the 2010–2011 MedPAR and All–Payor commercial databases were collected for patients with an acute myocardial infarction complicated by CS who received a pVAD (n = 883) or traditional surgical hemodynamic support alternatives (extracorporeal membrane oxygenation and extracorporeal VAD) (n = 305).
Discharge survival was greater with pVADs than with surgical alternatives (56% vs. 42%, P < 0.0001), resulted in a reduced LOS (13.2 and 17.9 days, respectively, P = 0.055) and a lower cost of the index admission ($90,929 and $144,257, respectively, P < 0.0001). Cost–effectiveness analysis based on the national data demonstrated that patients with pVADs had better outcomes at lower cost. Data were also collected for similar patients who underwent a protocol–guided Impella pVAD therapy at PinnacleHealth (Harrisburg, PA) between 2009 and 2011 (n = 30). Observed survival was greater (60% vs. 42%), LOS shorter (6 days vs. 17.9 days), and costs lower ($53,850 vs. $144,257) relative to the traditional surgical hemodynamic support alternatives. Sub–group analyses will also be conducted.
For patients in profound CS requiring emergent hemodynamic support, pVAD and Impella therapy offer a less invasive alternative that results in better outcomes, shorter LOS and lower costs. With no incremental cost and a survival benefit when compared to traditional surgical hemodynamic support alternatives, pVAD therapy nationally (and Impella in particular at PinnacleHealth) is emerging as a beneficial strategy for this challenging patient population.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.–10:45 a.m.
Session Title: Coronary Stents
Abstract Category: 47. TCT@ACC–i2: Coronary Intervention, Devices
Presentation Number: 2101–245
- 2013 American College of Cardiology Foundation