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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Percutaneous left ventricular support for high-risk PCI and cardiogenic shock: who gets what?
Roshni Shah1, Alexcis Thomson, Kimberly Atianzar
1Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
Insights
Percutaneous left ventricular assist devices (PLVADs) and intra-aortic balloon pumps (IABPs) show similar short-term outcomes in high-risk percutaneous coronary intervention and cardiogenic shock patients, despite differing patient profiles.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Percutaneous left ventricular assist devices (PLVADs) offer potential benefits for high-risk percutaneous coronary intervention (PCI) and cardiogenic shock (CS) patients.
- Comparing PLVADs with intra-aortic balloon pumps (IABPs) is crucial for optimizing treatment strategies.
Purpose of the Study:
- To compare the clinical outcomes and complication rates of PLVADs versus IABPs in patients undergoing high-risk PCI.
- To evaluate the effectiveness of PLVADs compared to IABPs in patients experiencing CS.
Main Methods:
- A retrospective analysis of 74 consecutive patients undergoing high-risk PCI or CS was conducted.
- Patients received either IABP, TandemHeart (TH), or Impella (IMP) devices, analyzed in separate high-risk PCI (n=57) and CS (n=17) cohorts.
- Primary endpoint: in-hospital major adverse cardiovascular events; Secondary endpoint: in-hospital vascular complications.
Main Results:
- In high-risk PCI, PLVAD patients had higher Syntax scores and more complex lesions than IABP patients, but similar outcomes.
- In CS, PLVAD patients had lower ejection fractions and more complex procedures than IABP patients, with similar outcomes.
- Both cohorts showed no significant difference in primary or secondary endpoints between PLVAD and IABP support.
Conclusions:
- Intra-aortic balloon pump (IABP) use versus percutaneous left ventricular assist device (PLVAD) use in high-risk PCI and CS is associated with distinct baseline patient, clinical, procedural, and angiographic characteristics.
- In-hospital clinical outcomes were comparable between IABP and PLVAD groups in both high-risk PCI and CS cohorts.
- Short-term clinical outcomes appear similar when physicians have access to both IABP and PLVAD devices.
Background:
Temporary use of a percutaneous left ventricular assist device (PLVAD) may be beneficial in patients undergoing high-risk percutaneous coronary intervention (PCI) and those with cardiogenic shock (CS).
Methods:
Seventy-four consecutive patients undergoing high-risk PCI and those with CS receiving intraaortic balloon pump (IABP), TandemHeart (TH), or Impella device (IMP) were enrolled. Patient undergoing high-risk PCI (n=57) and those treated for CS (n=17) were analyzed as separate cohorts. Patients undergoing IABP-assisted PCI were compared to those undergoing PLVAD (TH and IMP)-assisted PCI. The primary end point was in-hospital major adverse cardiovascular events, and the secondary end point was in-hospital vascular complications.
Results:
For the high-risk PCI cohort (n=57), 22 received PLVAD and 35 received IABP. Patients receiving IABP were younger and less likely to have a prior myocardial infarction (MI) and less likely to be on dialysis compared to those receiving PLVAD support. Patients receiving PLVAD support had a higher baseline Syntax score, had a higher prevalence of unprotected left main disease, underwent treatment of more coronary lesions, received more coronary stents, and more likely received drug-eluting stents compared to those receiving IABP support. The primary and secondary end points were similar between both groups. For the CS cohort (n=17), 4 received PLVAD and 13 received IABP. Patients receiving PLVAD support were more likely to have a prior MI, had a lower ejection fraction, underwent treatment of more coronary lesions, and received more coronary stents compared to those receiving IABP support. The primary and secondary end points were similar between both groups.
Conclusions:
IABP compared with PLVAD use for high-risk PCI and CS is associated with significantly different baseline patient, clinical, procedural, and angiographic characteristics. In-hospital clinical outcome was similar between both groups in both the high-risk PCI and the CS cohorts. When physicians have access to each of these devices, short-term clinical outcome appears to be similar.
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