Abstract 4364915: Early Percutaneous Ventricular Assist Device Use Is Associated with Higher In-Hospital Mortality in Non-Ischemic Cardiogenic Shock: A National Inpatient Sample Analysis

Abstract

Background: Cardiogenic shock (CS) is a life-threatening condition of inadequate organ perfusion due to cardiac failure. Although inotropes and vasopressors are standard treatments, they are linked with increased mortality and adverse effects. Mechanical circulatory support (MCS) devices such as intra-aortic balloon pump (IABP) and percutaneous ventricular assist devices (PVADs), including Impella, offer hemodynamic support with the potential for improved outcomes. While most evidence focuses on ischemic CS, the role and timing of PVAD in non-ischemic CS remain unclear. Objective: To evaluate the association between early (<24 hours) versus late (≥24 hours) PVADs use and in-hospital outcomes in patients with non-ischemic CS. Methods: We conducted a retrospective cohort study using the National Inpatient Sample from 2016–2022. We included adult patients with CS (ICD-10-CM R57.0) without concurrent acute myocardial infarction. Patients receiving PVADs (ICD-10-PCS) were categorized based on device implantation <24 or ≥24 hours from admission. The primary outcome was in-hospital mortality. Secondary outcomes included length of stay (LOS), hospitalization cost, and complications. Multivariable logistic and linear regression models were adjusted for demographics, comorbidities, and severity indicators. Results: Among 5,432 patients with non-ischemic CS treated with PVAD, 56.1% received early placement. In-hospital mortality was higher in the early group (39.6% vs 33.5%, p <0.001) and remained significant after adjustment. Early PVAD placement had shorter LOS (median 6 vs 17 days, p <0.001) and lower hospitalization cost (median $72,121 vs $123,166, p <0.001), likely reflecting early mortality. From 2016 to 2022, PVAD use increased (0.72% to 3.68%) while IABP use declined (10.2% to 5.5%). Conclusions: In patients with non-ischemic cardiogenic shock, early PVAD use was associated with increased mortality despite reduced resource utilization. These findings suggest early PVAD deployment may reflect greater disease acuity. Our findings suggest early PVAD placement may be harmful in some patients with non-ischemic CS and should not be used reflexively without clear clinical justification. Further studies are needed to clarify optimal timing and identify subgroups most likely to benefit from early support.