In-Hospital Mortality in Patients With Cardiogenic Shock Requiring Veno-Arterial Extracorporeal Membrane Oxygenation With Concomitant Use of Impella vs. Intra-Aortic Balloon Pump ― A Retrospective Cohort Study Using a Japanese Claims-Based Database ―
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- Nitta Manabu
- Department of Cardiology, Yokohama City University Graduate School of Medicine YCU Center for Novel and Exploratory Clinical Trials (Y-NEXT), Yokohama City University Hospital
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- Nakano Shintaro
- Department of Cardiology, Saitama Medical University International Medical Center
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- Kaneko Makoto
- Department of Health Data Science, Graduate School of Data Science, Yokohama City University
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- Fushimi Kiyohide
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences
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- Hibi Kiyoshi
- Department of Cardiology, Yokohama City University Graduate School of Medicine
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- Shimizu Sayuri
- Department of Health Data Science, Graduate School of Data Science, Yokohama City University
抄録
<p>Background: Patients with refractory cardiogenic shock (CS) necessitating peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) often require an intra-aortic balloon pump (IABP) or Impella for unloading; however, comparative effectiveness data are currently lacking.</p><p>Methods and Results: Using Diagnosis Procedure Combination data from approximately 1,200 Japanese acute care hospitals (April 2018–March 2022), we identified 940 patients aged ≥18 years with CS necessitating peripheral VA-ECMO along with IABP (ECMO-IABP; n=801) or Impella (ECPella; n=139) within 48 h of admission. Propensity score matching (126 pairs) indicated comparable in-hospital mortality between the ECPella and ECMO-IABP groups (50.8% vs. 50.0%, respectively; P=1.000). However, the ECPella cohort was on mechanical ventilator support for longer (median [interquartile range] 11.5 [5.0–20.8] vs. 9.0 [4.0–16.8] days; P=0.008) and had a longer hospital stay (median [interquartile range] 32.5 [12.0–59.0] vs. 23.0 [6.3–43.0] days; P=0.017) than the ECMO-IABP cohort. In addition, medical costs were higher for the ECPella than ECMO-IABP group (median [interquartile range] 9.09 [7.20–12.20] vs. 5.23 [3.41–7.00] million Japanese yen; P<0.001).</p><p>Conclusions: Our nationwide study could not demonstrate compelling evidence to support the superior efficacy of Impella over IABP in reducing in-hospital mortality among patients with CS necessitating VA-ECMO. Further investigations are imperative to determine the clinical situations in which the potential effect of Impella can be maximized.</p>
収録刊行物
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- Circulation Journal
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Circulation Journal advpub (0), 2024-01-12
一般社団法人 日本循環器学会