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Updated: Aug 18, 2025
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Left Ventricular Support for Unprotected Left Main Coronary Artery Interventions (The Dayton Heart and Vascular
Ali Abdul Jabbar1,2, Yaser Jbara1, Ali J Ebrahimi2
1Department of Cardiology, Wright State University Boonshoft School of Medicine, Fairborn, Ohio, US.
Insights
Percutaneous coronary artery intervention (PCI) for left main (LM) disease is feasible. In high-risk patients, Impella 2.5 support during LM PCI showed better outcomes than intra-aortic balloon pump (IABP) support.
Area of Science:
- Interventional Cardiology
- Cardiovascular Surgery
- Medical Devices
Background:
- Coronary artery bypass grafting (CABG) is standard for obstructive left main (LM) coronary disease.
- Percutaneous coronary artery intervention (PCI) is an alternative for patients unsuitable for CABG.
- Left main (LM) disease poses significant risks, necessitating careful treatment selection.
Purpose of the Study:
- To evaluate the safety and efficacy of LM PCI in a retrospective cohort.
- To compare outcomes of LM PCI with and without ventricular assist device (VAD) support.
- To assess the comparative effectiveness of Impella 2.5 versus intra-aortic balloon pump (IABP) in high-risk LM PCI patients.
Main Methods:
- Retrospective analysis of 89 patients undergoing LM PCI (January 2010 - March 2014).
- Obstructive LM disease defined as ≥50% angiographic stenosis.
- VAD support included Impella 2.5 or IABP; primary endpoint was inhospital mortality.
Main Results:
- VAD support (n=39) was associated with longer hospitalization (7.19 vs. 2.78 days, P<0.001).
- Higher incidence of cardiogenic shock (P=0.009) and inhospital mortality (P=0.001) in the VAD group.
- Inhospital mortality was 46% with IABP vs. 11% with Impella 2.5 (P=0.028).
Conclusions:
- Unsupported LM PCI is feasible and safe in selected patients.
- Impella 2.5 support demonstrated superior short-term outcomes compared to IABP in high-risk LM PCI.
- VAD use in LM PCI requires careful consideration due to increased mortality risks.
Background:
Coronary artery bypass grafting is the standard of care for patients with obstructive left main (LM) coronary disease. In poor surgical candidates, high-risk percutaneous coronary artery intervention (PCI) is an alternative.
Methods:
We investigated a retrospective cohort of patients who underwent LM PCI from January 2010 to March 2014 (n = 89). Obstructive LM disease was defined as 50% angiographic obstruction of luminal flow, and the primary endpoint was inhospital mortality. Ventricular assist device (VAD) was defined as the use of either intra-aortic balloon pump (IABP) or Impella 2.5 devices before, during, or following PCI.
Results:
A total of 89 patients with LM PCI were divided into those with (n = 39) and without (n = 50) VAD support. The former group was further divided into those with support from either Impella 2.5 (n = 28) or IABP (n = 11). Age, race, and gender did not differ between patients who received unassisted LM-PCI from those with VAD support (P = 0.142, 1.0, and 0.776, respectively). The angiographic stenosis of atherosclerotic lesions in LM, proximal left anterior descending artery, and other native/surgical coronary vessels was similar between the groups. The duration of hospitalization was significantly longer for patients with VAD support compared to those without (7.19 ± 6.89 vs. 2.78 ± 3.39, P < 0.001). The incidence of cardiogenic shock and inhospital mortality was significantly higher in the VAD group (P = 0.009 and 0.001, respectively). Overall, inhospital mortality was 9% (8/89). The IABP and Impella 2.5 groups had mortality proportions of 46% (5/11) and 11% (3/28), respectively; P = 0.028. For all patients, inhospital mortality was higher for those with versus without cardiogenic shock (56% or 5/9 vs. 4% or 3/80; P < 0.001), and for those with versus without left ventricular systolic function <40% (17% vs. 2%;P < 0.025).
Conclusion:
In a selected group of patients with LM disease, unsupported PCI appears to be a feasible and safe procedure. In high-risk patients, the use of Impella 2.5 appears to be superior to IABP in LM PCI resulting in favorable short-term outcomes.
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