Mechanical circulatory support in hypertrophic cardiomyopathy with cardiogenic shock: A National Inpatient Sample analysis.
TL;DR
In obstructive HCM complicated by cardiogenic shock, temporary MCS was associated with higher in-hospital mortality and substantially higher resource utilization, likely reflecting the greater severity of illness among patients selected for MCS rather than treatment-related harm.
Abstract
Background
Cardiogenic shock in patients with obstructive hypertrophic cardiomyopathy (HCM) is highly lethal. Temporary mechanical circulatory support (MCS), including percutaneous ventricular assist devices such as Impella and veno-arterial extracorporeal membrane oxygenation (VA-ECMO), is increasingly used in refractory cardiogenic shock. However, data regarding outcomes in this population remain limited.
Methods
We performed a retrospective cohort study using the National Inpatient Sample from 2016 to 2022. All adult patients with obstructive HCM complicated by cardiogenic shock were included and stratified by temporary MCS use. Survey-weighted multivariable regression evaluated the association between MCS use and in-hospital mortality, length of stay, and total hospital charges.
Results
A total of 4610 obstructive HCM hospitalizations with cardiogenic shock were identified; 280 (6.1%) underwent temporary MCS, most commonly VA-ECMO. MCS recipients were younger (58.2 vs 64.6 years, p < 0.01) and less frequently female (46.4% vs 61.0%, p = 0.03). In-hospital mortality was higher with MCS (42.9% vs 22.0%, p < 0.01). After multivariable adjustment, MCS remained independently associated with in-hospital death (aOR 2.88, 95% CI 1.46-5.69) and with higher total hospital charges (adjusted β $391,783, 95% CI $173,936-$609,631), but not with length of stay (β 5.5 days, 95% CI -1.3 to 12.2).
Conclusions
In obstructive HCM complicated by cardiogenic shock, temporary MCS was associated with higher in-hospital mortality and substantially higher resource utilization. These findings likely reflect the greater severity of illness among patients selected for MCS rather than treatment-related harm.