The impact of peripheral arterial disease on left ventricular assist device implantation: A propensity-matched analysis of the nationwide inpatient sample database.

Authors

• Waqas Ullah
• Salman Zahid
• Nishant Thalambedu
• Maria Khan
• Howard Massey
• Donald Haas
• Vakhtang Tchantchaleishvili
• Eduardo Rame

Publication/Presentation Date

8-1-2021

Abstract

Left ventricular assist device (LVAD) candidacy screening includes evaluation for peripheral arterial disease (PAD). However, given current evidence, the impact of PAD on post-LVAD complications remains unknown. The National Inpatient Sample (NIS) database (2002-2017) was utilized to identify all LVAD cases. The in-hospital safety endpoints included major cardiovascular adverse events and its components. A propensity-matched analysis was used to obtain adjusted odds ratios (aOR). A subgroup analysis of patients with diabetes mellitus (DM) with PAD was also performed. A total of 27 424 patients with LVAD implantation (PAD: 516 [1.8%] and no-PAD 26 908 [98.2%]) were included. There were significant intergroup differences in the demographics and baseline comorbidities. A weighted sample of 1053 (no-PAD 537, PAD 516) propensity-matched population was selected. The adjusted odds for in-hospital mortality (aOR 1.7; 95% CI, 1.2-2.44, P = .004) were found to be significantly higher for LVAD-patients with PAD. There was no significant difference in the adjusted odds of MACE (aOR 1.16, 95% CI 0.87-1.5), postprocedure bleeding (aOR 0.88, 95% CI 0.62-1.26, P = .54) and risk of pneumonia (aOR 0.67, 95% CI 0.44-1.15, P = .63) between the two groups. A selected cohort of DM-only population (7339) consistently showed a higher adjusted mortality rate in PAD patients with LVAD implantation (aOR 2.3, 95% CI 1.2-4.47, P = .01). The rate of MACE (P = .17), myocardial infarction (P = .12), stroke (P = .60), postprocedural (0.10), and major bleeding (P = .51) remained identical between patients with PAD and those with no-PAD. PAD confers an increased risk of in-hospital all-cause mortality in patients undergoing LVAD implantation. This risk increases further in patients with a concomitant diagnosis of DM.

Volume

45

Issue

8

First Page

838

Last Page

844

ISSN

1525-1594

Published In/Presented At

Ullah, W., Zahid, S., Thalambedu, N., Khan, M., Massey, H., Haas, D., Tchantchaleishvili, V., & Rame, E. (2021). The impact of peripheral arterial disease on left ventricular assist device implantation: A propensity-matched analysis of the nationwide inpatient sample database. Artificial organs, 45(8), 838–844. https://doi.org/10.1111/aor.13934

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

33559252

Department(s)

Administration and Leadership

Document Type

Article