Background:Percutaneous ventricular assist devices (PVADs) have been replacing intra-aortic balloon pumps for hemodynamic support during percutaneous coronary intervention (PCI), even though data supporting a benefit for hard clinical end points remain limited. We evaluated diffusion of PVADs across US markets and examined the association of market utilization of PVAD with mortality and cost.Methods:Using the 2013 to 2019 Medicare data, we identified all patients aged ≥65 years who underwent PCI with either a PVAD or intra-aortic balloon pump. We used hospital referral region to define regional health care markets and categorized them in quartiles based on the proportional use of PVADs during PCI. Multilevel models were constructed to determine the association of patient, hospital, and market factors with utilization of PVADs and the association of PVAD utilization with 30-day mortality and cost.Results:A total of 79 176 patients underwent PCI with either intra-aortic balloon pump (47 514 [60.0%]) or PVAD (31 662 [40.0%]). The proportion of PCI procedures with PVAD increased over time (17% in 2013 to 57% in 2019; P for trend, <0.001), such that PVADs overtook intra-aortic balloon pump for hemodynamic support during PCI in 2018. There was a large variation in PVAD utilization across markets (range, 0%–85%), which remained unchanged after adjustment of patient characteristics (median odds ratio, 2.05 [95% CI, 1.91–2.17]). The presence of acute myocardial infarction, cardiogenic shock, and emergent status was associated with a 45% to 50% lower odds of PVAD use suggesting that PVADs were less likely to be used in the sickest patients. Greater utilization of PVAD at the market level was not associated with lower risk mortality but was associated with higher cost.Conclusions:Although utilization of PVADs for PCI continues to increase, there is large variation in PVAD utilization across markets. Greater market utilization of PVADs was not associated with lower mortality but was associated with higher cost.

中文翻译：

---

经皮心室辅助装置在美国市场的普及


背景：经皮心室辅助装置 (PVAD) 已取代主动脉内球囊泵，以在经皮冠状动脉介入治疗 (PCI) 期间提供血流动力学支持，尽管支持硬临床终点获益的数据仍然有限。我们评估了 PVAD 在美国市场的扩散情况，并研究了 PVAD 的市场利用率与死亡率和成本的关系。方法：使用 2013 年至 2019 年的医疗保险数据，我们确定了所有年龄≥65 岁且接受 PCI 的患者，无论是采用 PVAD 还是内部治疗。主动脉球囊泵。我们使用医院转诊区域来定义区域医疗保健市场，并根据 PCI 期间 PVAD 的使用比例将其分类为四分位数。构建多层次模型以确定患者、医院和市场因素与 PVAD 使用的关系，以及 PVAD 使用与 30 天死亡率和费用的关系。结果：共有 79 176 名患者接受了主动脉内球囊 PCI 治疗泵 (47 514 [60.0%]) 或 PVAD (31 662 [40.0%])。随着时间的推移，采用 PVAD 的 PCI 手术比例不断增加（2013 年为 17%，2019 年为 57%；趋势P ，<0.001），因此 2018 年 PCI 期间，PVAD 取代了主动脉内球囊反搏泵用于血流动力学支持。不同市场的 PVAD 使用率存在差异（范围，0%–85%），调整患者特征后保持不变（中位比值比，2.05 [95% CI，1.91–2.17]）。急性心肌梗塞、心源性休克和紧急状态的存在与使用 PVAD 的几率降低 45% 至 50% 相关，这表明 PVAD 不太可能用于病情最严重的患者。在市场层面上更多地使用 PVAD 与较低的风险死亡率无关，但与较高的成本相关。结论：尽管 PCI 中 PVAD 的利用率持续增加，但不同市场的 PVAD 利用率存在很大差异。 PVAD 的更大市场利用率与较低的死亡率无关，但与较高的成本相关。