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Unprotected versus protected high-risk percutaneous coronary intervention with the Impella 2.5 in patients with
Tobias Becher1,2, Frederik Eder1, Stefan Baumann1,2
1First Department of Medicine-Cardiology, University Medical Centre Mannheim.
Insights
Protected percutaneous coronary intervention (PCI) using Impella 2.5 in patients with multivessel disease and reduced ejection fraction showed similar outcomes to unprotected PCI. This high-risk PCI approach demonstrated comparable one-year major adverse cardiac and cerebrovascular events rates.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Surgery
Background:
- Multivessel disease (MVD) with severely reduced left ventricular ejection fraction (LVEF ≤35%) presents a complex revascularization challenge.
- Percutaneous coronary intervention (PCI) with Impella 2.5 support may enable high-risk procedures, but long-term comparisons between protected and unprotected PCI are lacking.
Purpose of the Study:
- To evaluate and compare the clinical outcomes of protected PCI versus unprotected PCI in patients with MVD and severely reduced LVEF.
- To assess the safety and efficacy of Impella 2.5-assisted PCI in this high-risk patient population.
Main Methods:
- Retrospective, single-centre study comparing patients with MVD and LVEF ≤35% who underwent unprotected PCI versus protected PCI with Impella 2.5.
- Primary endpoint: major adverse cardiac and cerebrovascular events (MACCE) at 1-year follow-up.
- Secondary endpoints: in-hospital MACCE and adverse events.
Main Results:
- 61 patients included (28 with protected PCI). No significant difference in 1-year MACCE between protected (26.7%) and unprotected PCI groups (P=0.90).
- In-hospital MACCE (P=1.00) and adverse events (P=0.12) were also similar between groups.
- Complete revascularization and absence of in-hospital complications were protective against MACCE (OR 0.17, P=0.02).
Conclusions:
- Protected PCI with Impella 2.5 in patients with MVD and severely depressed LVEF yields similar in-hospital and 1-year outcomes compared to unprotected PCI.
- The findings support the use of Impella 2.5 for high-risk PCI in this vulnerable patient group, emphasizing procedural success.
- Further prospective studies are warranted to confirm these results in a larger cohort.
Abstract:
Selecting a revascularization strategy in patients with multivessel disease (MVD) and severely reduced left ventricular ejection fraction (LVEF) remains a challenge. PCI with Impella 2.5 may facilitate high-risk PCI, however long-term results comparing unprotected versus protected PCI are currently unknown. We sought to evaluate the outcome of patients undergoing protected compared to unprotected percutaneous coronary intervention (PCI) in the setting of MVD and severely reduced LVEF.We included patients with MVD and severely reduced LVEF (≤35%) in this retrospective, single-centre study. Patients that underwent unprotected PCI before the start of a dedicated protected PCI program with Impella 2.5 were compared to patients that were treated with protected PCI after the start of the program. The primary endpoint was defined as major adverse cardiac and cerebrovascular events (MACCE) during a 1-year follow-up. The secondary endpoints consisted of in-hospital MACCE and adverse events.A total of 61 patients (mean age 70.7 ± 10.9 years, 83.6% male) were included in our study, of which 28 (45.9%) underwent protected PCI. The primary endpoint was reached by 26.7% and did not differ between groups (P = .90). In-hospital MACCE (P = 1.00) and in-hospital adverse events (P = .12) also demonstrated no significant differences. Multivariate logistic regression identified procedural success defined as complete revascularization and absence of in-hospital major clinical complications as protective parameter for MACCE (OR 0.17, 95% CI 0.04-0.70, P = .02).Patients with MVD and severely depressed LVEF undergoing protected PCI with Impella 2.5 demonstrate similar in-hospital and one-year outcomes compared to unprotected PCI.
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