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Published on: June 12, 2021
Short term outcomes of Impella circulatory support for high-risk percutaneous coronary intervention a systematic
Edoardo Elia1, Mario Iannaccone2, Fabrizio D'Ascenzo1
1Division of Cardiology, Department of Medical Science, University of Turin, Turin, Italy.
Insights
This study found Impella use in high-risk percutaneous coronary intervention (HR-PCI) has acceptable short-term safety. Complication rates, particularly vascular and bleeding events, were manageable in this patient population.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Limited data exist on the short-term outcomes of Impella use in high-risk percutaneous coronary intervention (HR-PCI).
- Previous studies highlight the clinical significance of Impella in HR-PCI, necessitating further investigation into its immediate safety and efficacy.
Purpose of the Study:
- To evaluate the short-term safety and efficacy of Impella device utilization in patients undergoing high-risk percutaneous coronary intervention (HR-PCI).
Main Methods:
- A systematic review and meta-analysis of studies reporting short-term outcomes of PCI supported by any Impella device.
- Primary endpoint: in-hospital or 30-day mortality.
- Secondary outcomes: vascular complications, post-procedural stroke, dialysis, and bleeding events.
Main Results:
- Nine studies including 7448 patients were analyzed, with a median age of 69.5 years and low ejection fraction (29.7%).
- In-hospital mortality was 5.09%, vascular complications occurred in 2.53%, stroke in 2.77%, and major bleeding in 5.98% of patients.
- Impella 2.5 was the most frequently used device (88.7%) for hemodynamic support during PCI.
Conclusions:
- The use of Impella in high-risk PCI demonstrates an acceptable safety profile.
- Rates of vascular complications and major bleeding were found to be manageable in the studied HR-PCI population.
Objective:
Aim of this study is to evaluate short term safety and efficacy of Impella in high risk percutaneous coronary intervention (HR-PCI) population.
Background:
While several studies demonstrated the clinical significance of Impella in HR-PCI, few data exist about its impact on short term outcome.
Methods:
All studies reporting short term outcomes of PCI with any Impella device were included. The primary endpoint was either in-hospital or 30-day mortality, while vascular complications, post-procedural stroke, post-procedural dialysis and bleeding complications were assessed as secondary outcomes.
Results:
Nine studies with 7448 patients were included. Median age was 69.5 years old (67-73), with a mean ejection fraction of 29.7% (20%-39%) and a Syntax score of 30.2 (25. 5-33, interquartile [IQR]). Impella 2.5 was the most commonly used axial flow pump used to support these PCIs (88.7%). In-hospital death was observed in 5.09% of patients (95% confidence interval [CI] 3.69-6.49, I2 = 78%), while vascular complications in 2.53% of patients (1.07-4.00, I2 = 89%) and post-procedural stroke in 2.77% of patients (0.50-6.05, I2 = 98%). Major bleeding occurred in 5.98% of patients (3.66-8.31, I2 = 90%) and post-procedural dialysis in 4.44% of patients (1.50-7.37, I2 = 93% all CI 93%).
Conclusion:
Use of Impella in high risk PCI appears to have an acceptable rate of complication, especially regarding vascular complications and major bleedings.
