Unprotected Left Main Percutaneous Coronary Intervention With or Without Hemodynamic Support

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Medical Device Technology

Background:

• Hemodynamic support, such as intra-aortic balloon pump (IABP), is frequently used during unprotected left main (ULM) percutaneous coronary interventions (PCI).
• However, evidence from randomized studies supporting routine IABP use in ULMPCI is lacking, and device-related complications are a concern.

Purpose of the Study:

• To compare the clinical, procedural, and cardiovascular outcomes of ULMPCI performed with and without elective intra-aortic balloon pump (IABP) support.
• To evaluate the safety and efficacy of unsupported ULMPCI versus IABP-supported ULMPCI.

Main Methods:

• A single-center, retrospective analysis of 217 patients undergoing non-emergent ULMPCI between 2003 and 2018.
• Patients were divided into two groups: those who received elective IABP support (n=55) and those who did not (n=162).
• Comparison of procedural success, in-hospital and 30-day mortality, major complications, and length of hospital and intensive care unit stay.

Main Results:

• Procedural success rates were high in both groups (99% with IABP, 95.3% without IABP; p=0.089).
• In-hospital and 30-day mortality rates were similar between the IABP and No-IABP groups (5.5% vs. 5.6%; p=0.977).
• Rates of major complications were comparable, although the IABP group experienced longer hospital and ICU stays. Bailout IABP was needed in 10% of the No-IABP group.

Conclusions:

• Unprotected left main percutaneous coronary interventions (ULMPCI) performed without intra-aortic balloon pump (IABP) support were not associated with increased mortality or major adverse cardiovascular outcomes compared to those with IABP.
• Unsupported ULMPCI was associated with shorter hospital and intensive care unit lengths of stay.
• A randomized trial is warranted to definitively identify patient subgroups who may benefit from hemodynamic support during ULMPCI.