Temporal trends in the use of intraaortic balloon pump associated with percutaneous coronary intervention in the United States, 1998-2008

Abstract

Background: With conflicting evidence regarding the usefulness of intraaortic balloon pump (IABP), reports of IABP use in the United States have been inconsistent. Our objective was to examine trends in IABP usage in percutaneous coronary intervention (PCI) in the United States and to evaluate the association of IABP use with mortality.

Methods: This is a retrospective, observational study using patient data obtained from the Nationwide Inpatient Sample database from 1998 to 2008. Patients undergoing any PCI (1,552,602 procedures) for a primary diagnosis of symptomatic coronary artery disease and acute coronary syndrome, including non-ST-elevation myocardial infarction and ST-elevation myocardial infarction, were evaluated.

Results: The overall use of IABP significantly decreased during the study period from 0.99% in 1998 to 0.36% in 2008 (univariate and multivariate P for trend < .0001). Patients who received IABP had substantially higher rates of shock compared with those who did not receive IABP (38.09% vs 0.70%; P < .0001), which was associated with markedly higher inhospital mortality rates (20.31% vs 0.72%; P < .0001). However, IABP use significantly decreased in patients with shock (36.5%-13.4%) and acute myocardial infarction (2.23%-0.84%) (univariate and multivariate P for trend for both < .0001). A temporal reduction in all-cause PCI-associated mortality from 1.1% in 1998 to 0.86% in 2008 (univariate and multivariate P for trend < .0001) was also observed.

Conclusions: The utilization of IABP associated with PCI significantly decreased between 1998 and 2008 in the United States, even among patients with acute myocardial infarction and shock.

Figure 1

Flow Diagram of study patients NIS, Nationwide Inpatient Sample; PCI, percutaneous coronary intervention; CAD, coronary artery disease; ACS, acute coronary syndrome; NSTEMI, non-ST elevation myocardial infarction; STEMI, ST-elevation myocardial infarction; IABP, intraaortic balloon pump; CABG, coronary artery bypass graft; VAD, ventricular assist device

Figure 2

Trend in overall IABP use in PCI from 1998–2008. IABP, intraaortic balloon pump

Figure 3

Independent predictors for IABP placement in PCI. AMI indicates acute myocardial infarction; CAD, coronary artery disease; CHF, congestive heart failure; TIA, transient ischemic attack; PVD, peripheral vascular disease; A/V/P, Aortic/peripheral/visceral; COPD, chronic obstructive pulmonary disease; SLE, systemic lupus erythematosus; CVD, cerebrovascular disease

Figure 4

a. Trend in overall percentage of patients with shock by year from 1998–2008. Trend in IABP use in shock by year from 1998–2008. b. Trend in overall percentage of patients with AMI by year from 1998–2008. Trend in IABP use in AMI by year from 1998–2008.

Figure 5

Trend in all-cause, in-hospital mortality in PCI from 1998–2008. Trend in death with IABP use in PCI from 1998–2008. IABP, intraaortic balloon pump

Figure 6

Independent predictors for all-cause, in-hospital mortality in all patients undergoing PCI. AMI indicates acute myocardial infarction; CAD, coronary artery disease; CHF, congestive heart failure; TIA, transient ischemic attack; PVD, peripheral vascular disease; A/V/P, Aortic/peripheral/visceral; COPD, chronic obstructive pulmonary disease; SLE, systemic lupus erythematosus; CVD, cerebrovascular disease; CABG, coronary artery bypass graft; VAD, ventricular assist device