Clinical outcomes in patients undergoing complex, high-risk percutaneous coronary intervention and haemodynamic support with intra-aortic balloon versus Impella pump: Real-life single-centre preliminary results
Background: Patients and mechanical circulatory support assortment, as well as peri-procedural and post-procedural clinical outcomes in complex, high-risk percutaneous coronary interventions (PCIs), underpinned by percutaneous left ventricle assist devices (pLVAD), are a disputable debate.
Aim: The aim of the study was to seek differences between patients qualified for complex, high-risk PCIs with an intra-aortic balloon pump (IABP) or Impella pump support, and to compare peri- and post-procedural clinical outcomes.
Methods: The presented analysis is a single-centre study, which comprised consecutive patients undergoing complex, high-risk PCIs performed with the pLVAD, either IABP or Impella. Patients included in the current analysis were recruited between January 2018 and December 2021. There were 28 (56%) patients in the Impella group and 22 (44%) in the IABP group. The primary endpoints comprised overall mortality and major adverse cardiovascular events (MACE). These included all-cause mortality, myocardial infarction, revascularisation and cerebrovascular events.
Results: Patients from the IABP group were significantly older, had higher left ventricular ejection fraction and less frequent history of PCI, while the in-hospital risk of death assessed by Euroscore II remained similar in the Impella and IABP groups median (interquartile range [IQR]) (2.8 [2–3.8] vs. 2.5 [1.8–5.2], P = 0.73). Patients undergoing complex, high-risk PCIs with pLVAD support presented similar results during the follow-up, assessed by log-rank estimates in terms of MACE (p = 0.41) and mortality rate (p = 0.65).
Conclusions: The use of pLVAD devices in patients undergoing complex, high-risk PCIs, with reduced left ventricular ejection fraction, is a promising treatment option for patients disqualified for surgery cardiac surgeons
