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Updated: Nov 4, 2025
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Outcomes of bailout percutaneous ventricular assist device versus prophylactic strategy in patients undergoing
Brian P O'Neill1, Cindy Grines2, Jeffrey W Moses3
1Department of Cardiology, Henry Ford Hospital Center for Structural Heart, Detroit, Michigan, USA.
Insights
Bailout percutaneous ventricular assist device (pVAD) support during high-risk percutaneous coronary intervention (HRPCI) is linked to significantly higher in-hospital mortality compared to prophylactic pVAD support. Female patients were more frequently in the bailout group, warranting further investigation.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- High-risk percutaneous coronary intervention (HRPCI) carries a risk of hemodynamic collapse.
- Percutaneous ventricular assist devices (pVAD) offer hemodynamic support during PCI.
- Two strategies exist: prophylactic pVAD support before PCI and bailout pVAD support during collapse.
Purpose of the Study:
- To compare in-hospital outcomes between prophylactic and bailout pVAD support in HRPCI.
- To evaluate the effectiveness and safety of different pVAD support strategies.
Main Methods:
- Retrospective analysis of 1,028 patients from the cVAD and USpella databases.
- Comparison of outcomes between the prophylactic Impella Protected PCI (ProPCI) group (971 patients) and the bailout Impella support group (57 patients).
- Statistical analysis of in-hospital mortality and patient demographics.
Main Results:
- The bailout group had significantly higher unadjusted and adjusted in-hospital mortality (49.1% and 57.8%) compared to the ProPCI group (4.3% and 4.4%).
- Patients in the bailout group were more frequently female (50.9% vs. 27.2%) and had higher baseline LVEF (40% vs. 30%).
- The bailout group had a lower prevalence of heart failure (42.1% vs. 56.9%) and left main disease (40.0% vs. 56.1%).
Conclusions:
- Bailout pVAD support during HRPCI is associated with significantly increased in-hospital mortality compared to prophylactic support.
- Female gender is more prevalent in patients requiring bailout pVAD.
- Further research is needed to generalize these findings.
Objectives:
To compare in-hospital outcomes of bailout support to prophylactic support with percutaneous ventricular assist devices (pVAD) for high-risk nonemergent percutaneous coronary intervention (HRPCI).
Background:
Prophylactic support with pVAD for a HRPCI is used in patients felt to be at risk for hemodynamic collapse during PCI. An alternative strategy of bailout pVAD support in the event of hemodynamic collapse is also entertained.
Methods:
We compared the outcomes of patients entered in the cVAD database who underwent Impella Protected PCI (ProPCI group) with patients from the cVAD and USpella databases receiving bailout Impella support for hemodynamic collapse during HRPCI (Bailout group).
Results:
A total of 1,028 patients supported with Impella pVAD were entered into the cVAD database as of July 2019 and were included in this analysis. Of those 971 were in the ProPCI group and 57 in the Bailout group. Patients in the Bailout group were more often female (50.9%vs. 27.2%, p = .0002) with higher median baseline left ventricular ejection fraction (LVEF) (40%vs. 30%, p < .0001) and with lower prevalence of both heart failure (42.1%vs. 56.9%, p = .0385) and left main disease (40.0%vs. 56.1%, p = .0250) compared to the ProPCI group. Unadjusted and adjusted in-hospital mortality was significantly higher in the Bailout group (49.1%vs. 4.3%, and 57.8%vs. 4.4%, p < .0001 for both).
Conclusions:
In our study population, the bailout group was associated with significant increased mortality compared to ProPCI group. Female gender was more frequently observed in patients requiring bailout pVAD. Further investigation is warranted in order to generalize the findings of our study.
