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Published on: June 12, 2021
Complex High-Risk Indicated Percutaneous Coronary Intervention With Prophylactic Use of the Impella CP Ventricular
Deborah M F van den Buijs, Floris S van den Brink1, Adriaan Wilgenhof
1Leids Universitair Medisch Centrum, Leiden, Zuid-Holland, 2333ZA, The Netherlands. floris.s.van.den.brink@gmail.com.
Insights
High-risk percutaneous coronary intervention (PCI) using the Impella CP device is a feasible option for complex higher-risk indicated patients (CHIPs) when surgery is not possible. This approach provided adequate hemodynamic support with acceptable outcomes in a recent study.
Area of Science:
- Interventional Cardiology
- Cardiovascular Surgery
- Medical Devices
Background:
- Complex higher-risk indicated patients (CHIPs) present significant challenges for revascularization strategies due to extensive coronary artery disease and comorbidities.
- Coronary artery bypass grafting (CABG) may be too high-risk or impossible for many CHIPs, necessitating alternative treatment options.
Purpose of the Study:
- To evaluate the feasibility and outcomes of high-risk percutaneous coronary intervention (PCI) supported by the Impella CP ventricular assist device in CHIPs.
- To assess the safety and efficacy of Impella CP-facilitated PCI as an alternative to surgery in a high-risk cardiac population.
Main Methods:
- A retrospective, multicenter study included consecutive CHIPs who underwent Impella CP-facilitated complex high-risk PCI.
- Patients were declined for surgery by a heart team, and periprocedural mechanical circulatory support was deemed necessary.
- Data on demographics, clinical and procedural characteristics, and 30-day outcomes, including major adverse cardiac events (MACE) and mortality, were collected.
Main Results:
- Twenty-seven CHIPs (median age 73 years, 74.1% men) were analyzed, with a median SYNTAX score of 32 and EuroSCORE of 7.25%.
- In-hospital and 30-day mortality was 7.4%. Major adverse cardiac event (MACE) occurred in 37.0% of patients, and bleeding complications in 22.2%.
- The Impella CP device provided adequate hemodynamic support with a median run time of 1.22 hours, no significant kidney function decline, and a median admission time of 3 days.
Conclusions:
- The Impella CP system demonstrated good feasibility for providing hemodynamic support during high-risk PCI in the CHIP population.
- Impella CP-facilitated PCI serves as a viable alternative for CHIPs unsuitable for surgical revascularization, offering acceptable short-term outcomes.
Objectives:
Patients with complex coronary artery disease, concomitant cardiac disease, and multiple comorbidities are addressed as complex higher-risk indicated patients (CHIPs). Selecting a revascularization strategy in this population remains challenging. If coronary artery bypass grafting is deemed high risk or patients are considered inoperable, high-risk percutaneous coronary intervention (PCI) with the support of the Impella CP ventricular assist device (Abiomed) may be an attractive alternative.
Methods:
In this retrospective, multicenter study, we included consecutive patients undergoing Impella CP-facilitated complex high-risk PCI. All patients were discussed by the heart team and were declined for surgery. Additionally, periprocedural mechanical circulatory support was deemed necessary. We collected demographic, clinical, and procedural characteristics. Major adverse cardiac event (MACE) and mortality rates up to 30 days were evaluated.
Results:
A total of 27 patients (median age, 73 ± 9.7 years; 74.1% men) were included in our study. The median SYNTAX score was 32 (range, 8-57) and EuroSCORE was 7.25% (range, 1.33-49.66; ± 12.76%). Periprocedural hemodynamic instability was observed in 1 patient (3.7%). In-hospital combined with 30-day mortality was 7.4% (2/27). No repeat revascularization was necessary. MACE was observed in 10 patients (37.0%). Six patients (22.2%) had a major bleeding complication, of which 2 were related to Impella access site. Median Impella run time was 1.22 hours and there was no significant decrease in kidney function. Median admission time after PCI was 3 days (range, 1-23; ± 4.76).
Conclusions:
The Impella CP system showed good feasibility and provided adequate hemodynamic support during high-risk PCI in this CHIP population.
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