In-hospital outcomes of percutaneous ventricular assist devices versus intra-aortic balloon pumps in non-ischemia related cardiogenic shock Gbolahan O. Ogunbayo, MD a,1, *, Le Dung Ha, MD b,1 , Qamar Ahmad, MD b , Naoki Misumida, MD a , Ayman Elbadawi, MD, MS b , Odunayo Olorunfemi, MD, MPH b , Andrew Kolodziej, MD a , Adrian W. Messerli, MD a , Ahmed Abdel-Latif, MD, PhD a , Claude S. Elayi, MD a , Maya Guglin, MD, PhD a a University of Kentucky, Lexington, Kentucky b Department of Internal Medicine, Rochester General Hospital, Rochester, New York A R T I C L E I N FO Article history: Received 14 October 2017 Accepted 4 February 2018 Available online Keywords: Cardiogenic shock Percutaneous ventricular assist devices Intra-aortic balloon pump Heart failure Impella devices Mechanical circulatory support A B ST R AC T Introduction: This study compared inpatient outcomes related to the use of these two devices among pa- tients who developed cardiogenic shock not due to acute myocardial infarction or coronary revascularization. Methods: We extracted admission-level records of patients with a diagnosis of cardiogenic shock who underwent either PVAD or IABP implantation from the National Inpatient Sample (NIS) database from 2010 to 2014. Our outcomes of interest were mortality and length of stay. Results: Inpatient mortality was significantly higher in the PVAD cohort. In multivariate analysis, PVAD use in these patients was associated with higher mortality. There was no difference in the length of stay between both groups among patients that survived to discharge. Conclusion: In our analysis of the NIS database, the use of PVADs in patients with cardiogenic shock of non-ischemic origin was associated with higher mortality when compared to IABP use. © 2018 Elsevier Inc. All rights reserved. Introduction Cardiogenic shock (CS) is characterized by a state of low cardiac output and inadequate organ perfusion due to the failure of the pumping mechanism of the heart. 1 Despite major advances in med- icine, including invasive circulatory monitoring and reperfusion strategies, in-hospital mortality from CS remains exceptionally high. 2 The mainstay of CS management, besides coronary revascularization when indicated, is aggressive support of the failing heart with inotrope therapy, especially during the acute phase. 3 Recently, the use of short-term mechanical circulatory support (MCS) devices, which act as a bridge towards a more definitive therapy, has increased in clinical practice. 4 Current, the Food and Drug Ad- ministration (FDA) approved devices for MCS include the intra- aortic balloon pump (IABP), percutaneous ventricular assist devices (PVAD) such as the Impella™ (left ventricle-to-aorta assist), the TandemHeart™ (left atrium-to-femoral assist) and extracorporeal membrane oxygenation (ECMO). The IABP is a rapidly deployable, percutaneous MCS device that has been used in the management of cardiogenic shock for decades. It does not directly contribute to cardiac output, although there are some reports indicating an increase in cardiac output of between 0.5 and 1.0 L/min, or up to 30%. 5,6 The primary function of IABP is to augment diastolic pressure and decreases afterload by inflating during diastole and deflating during systole, respectively. 7 PVADs have been available for clinical use for CS for less than a decade. They are believed to provide more reliable support by directly increasing cardiac index, thus achieving better hemodynamic pa- rameters in CS patients. 8 The presumed superior hemodynamic support of PVADs, coupled with a lack of survival benefit with IABP has resulted in the increased use of PVADs in the management of acute CS. 6–11 The Institutional review boards at the University of Kentucky and Rochester General Hospital deemed this study exempt as it is a de-identified, publicly avail- able database. Conflict of interests: The authors have no conflict of interest to disclose. Disclosures: None. Funding: Penny Warren Research Award, University of Kentucky; Dr. Abdel- Latif is supported by the University of Kentucky Clinical and Translational Science Pilot Award (UL1TR000117), the UK COBRE Early Career Program (P20 GM103527) and the NIH Grant R56 HL124266. * Corresponding author. Fax: (859) 323-6475. E-mail address: Gbolahanogunbayo@yahoo.com (G.O. Ogunbayo). 1 Co-first authors. 0147-9563/$ – see front matter © 2018 Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.hrtlng.2018.02.002 Heart & Lung ■■ (2018) ■■–■■ ARTICLE IN PRESS Contents lists available at ScienceDirect Heart & Lung journal homepage: www.heartandlung.com