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Acute myocardial infarction (AMI) in women has been associated with a high prevalence of cardiogenic shock. Percutaneous ventricular assist devices (PVAD) are frequently used in patients in AMI associated cardiogenic shock. We sought to describe outcomes and procedure-related complications in females undergoing percutaneous coronary intervention (PCI) and PVAD placement for AMI.
The study population was derived from the HCUP-NIS database for the years 2002-2013. ICD-9 codes were used to identify female patients presenting with AMI requiring PVAD placement during PCI. Patients receiving either Impella or TandemHeart were included in the PVAD cohort. In-hospital all-cause mortality, total cost of hospitalization, mean length of stay and complications rates were assessed. Propensity score matching was used to adjust for patient and procedural confounders.
Among 6,684 patients undergoing PVAD placement during the study period, 1,819 (27.2%) were female. Female patients were older (69.8 vs. 66.1, p<0.0001) with a higher incidence of obesity, hypertension, diabetes, heart failure, peripheral vascular disease, asthma, thyroid and valve disorders. Almost one third of the patients who received PVAD also received IABP. In-hospital all-cause mortality and length of stay were comparable between the two groups; incidence of vascular complications and blood transfusion were higher in the female cohort, while incidence of acute stroke, acute kidney injury and cost of hospitalization were lower. After propensity score adjustment, in-hospital all-cause mortality, cost of hospitalization, blood transfusions and rates of vascular complications remained higher in the female cohort (Table 1).
PVAD placement in females with AMI undergoing PCI is associated with increased all-cause mortality, cost of hospitalization, blood transfusions and vascular complications compared to male patients.
CORONARY: Acute Myocardial Infarction