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Published on: June 12, 2021
Prophylactic Mechanical Circulatory Support Use in Elective Percutaneous Coronary Intervention for Patients With
Michel Zeitouni1, Guillaume Marquis-Gravel1, Nathaniel R Smilowitz2
1Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (M.Z., G.M.G., P.Z., D.M.W., S.V.R., T.Y.W.).
Insights
Prophylactic use of mechanical circulatory support (MCS) in elective percutaneous coronary intervention (PCI) for stable coronary artery disease increased from 2009 to 2018. Intra-aortic balloon pump use showed higher adverse cardiac events but fewer complications than other MCS devices.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Mechanical circulatory support (MCS) devices are utilized in high-risk percutaneous coronary intervention (PCI).
- Trends and outcomes of prophylactic MCS use in elective PCI for stable coronary artery disease (CAD) were analyzed.
- Data was sourced from the American College of Cardiology National Cardiovascular Data Registry's CathPCI registry.
Purpose of the Study:
- To describe trends in prophylactic mechanical circulatory support (MCS) device utilization.
- To compare the effectiveness and safety of different prophylactic MCS devices in elective PCI.
- To analyze outcomes in patients with stable coronary artery disease undergoing elective PCI.
Main Methods:
- Analysis of 2,108,715 patients with stable CAD undergoing elective PCI (2009-2018).
- Examination of prophylactic MCS use patterns, including intra-aortic balloon pump (IABP) versus other MCS (Impella, ECMO).
- Propensity score models with inverse probability of treatment weighting were used for comparative effectiveness and safety analysis.
Main Results:
- Prophylactic MCS use increased from 0.2% to 0.6% of elective PCIs, driven by devices other than IABP.
- In-hospital major adverse cardiac events (MACE) and cardiovascular complications were higher in patients receiving prophylactic MCS compared to those without.
- IABP use was linked to higher MACE (9.6% vs. 6.0%) but lower procedural complications (18.2% vs. 19.1%) compared to other MCS.
Conclusions:
- Prophylactic MCS use in elective PCI for stable CAD has risen over time.
- Intra-aortic balloon pump (IABP) use was associated with increased major adverse cardiac events.
- Other MCS devices demonstrated a lower risk of procedural complications compared to IABP.
Background:
Mechanical circulatory support (MCS) devices can be used in high-risk percutaneous coronary intervention (PCI). Our objective was to describe trends and outcomes of prophylactic MCS use in elective PCI for patients with stable coronary artery disease in the American College of Cardiology National Cardiovascular Data Registry's CathPCI registry.
Methods:
Among 2 108 715 consecutive patients with stable coronary artery disease undergoing elective PCI in the CathPCI registry between 2009 and 2018, we examined patterns of prophylactic use of MCS. Propensity score models with inverse probability of treatment weighting compared effectiveness (in-hospital death, cardiogenic shock, or new heart failure) and safety (stroke, tamponade, major bleeding, or vascular complication requiring treatment) between patients treated with intra-aortic balloon pump versus other MCS (Impella or extracorporeal membrane oxygenation).
Results:
Overall, 6905 (0.3%) patients underwent elective PCI with prophylactic MCS. MCS use trended up from 0.2% of elective PCIs in 2009 to 0.6% in 2018 (P<0.0001), driven by other MCS (P<0.0001), whereas intra-aortic balloon pump use remained low and constant (P=0.12). In-hospital major adverse cardiac events and cardiovascular complications occurred in 7.1% and 18.8% of elective PCI patients with prophylactic MCS use and 0.5% and 2.3% of patients without prophylactic MCS use. Intra-aortic balloon pump use was associated with a higher risk of major adverse cardiac events (9.6% versus 6.0%, adjusted odds ratio, 1.59 [95% CI, 1.32-1.91]) but lower risk of complications (18.2% versus 19.1%, adjusted odds ratio, 0.88 [95% CI, 0.77-0.99]) than use of other MCS.
Conclusions:
The use of prophylactic MCS has increased over time for elective PCI in patients with stable coronary artery disease. Intra-aortic balloon pump was associated with higher major adverse cardiac events but lower risk of procedural complications compared with other MCS.
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