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Updated: Jul 7, 2025
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Influence of left ventricular ejection fraction in patients undergoing contemporary pLVAD-supported high-risk PCI
Arsalan Abu-Much1, Cindy L Grines2, Wayne B Batchelor3
1Clinical Trials Center, Cardiovascular Research Foundation, New York, NY.
Insights
Left ventricular systolic dysfunction impacts outcomes in high-risk percutaneous coronary intervention (HRPCI) patients. However, percutaneous left ventricular assist device (pLVAD)-supported HRPCI shows low complications, with LV ejection fraction (LVEF) impacting MACCE and mortality.
Area of Science:
- Cardiology
- Interventional Cardiology
- Heart Failure
Background:
- Left ventricular (LV) systolic dysfunction is a known predictor of adverse outcomes in patients undergoing percutaneous coronary intervention (PCI).
- High-risk PCI (HRPCI) involves complex procedures often requiring hemodynamic support.
Purpose of the Study:
- To evaluate the outcomes of patients undergoing HRPCI supported by a percutaneous left ventricular assist device (pLVAD).
- To stratify outcomes based on baseline left ventricular ejection fraction (LVEF).
Main Methods:
- Patients from the PROTECT III study undergoing pLVAD-supported HRPCI were analyzed.
- Stratification was based on baseline LVEF: severe (<30%), mild-moderate (≥30% to <50%), and preserved (≥50%).
- Major adverse cardiovascular and cerebrovascular events (MACCE) and PCI-related complications were assessed at 90 days; mortality at 1 year.
Main Results:
- Immediate PCI-related complications were infrequent (2.7%) and similar across LVEF groups.
- Unadjusted 90-day MACCE rates were similar among LVEF groups.
- Lower LVEF, as a continuous variable, was significantly associated with increased 90-day MACCE (adj.HR per 5% 0.89) and 1-year mortality (adj.HR per 5% 0.84).
Conclusions:
- pLVAD-supported HRPCI demonstrates a low incidence of procedural complications, irrespective of baseline LVEF.
- Baseline LVEF remains a significant independent predictor of both short-term MACCE and long-term mortality after pLVAD-supported HRPCI.
Background:
Left ventricular (LV) systolic dysfunction worsens outcomes in patients undergoing percutaneous coronary intervention (PCI). The objective of this study, therefore, was to evaluate outcomes of pLVAD-supported high-risk PCI (HRPCI) patients according to LV ejection fraction (LVEF).
Methods:
Patients from the PROTECT III study undergoing pLVAD-supported HRPCI were stratified according to baseline LVEF: severe LV dysfunction (LVEF <30%), mild and moderate LV dysfunction (LVEF ≥30% to <50%), or preserved LV function (LVEF ≥50%). Major adverse cardiovascular and cerebrovascular events (MACCE: composite of all-cause death, myocardial infarction, stroke/transient ischemic attack, and repeat revascularization), and PCI-related complications were assessed at 90 days and mortality was assessed at 1-year.
Results:
From March 2017 to March 2020, 940 patients had evaluable baseline LVEF recorded in the study database. Patients with preserved LV function were older, more frequently presented with myocardial infarction, and underwent more left main PCI and atherectomy. Immediate PCI-related coronary complications were infrequent (2.7%, overall), similar between groups (P = 0.98), and not associated with LVEF. Unadjusted 90-day MACCE rates were similar among LVEF groups; however, as a continuous variable, LVEF was associated with both 90-day MACCE (adj.HR per 5% 0.89, 95% CI [0.80, 0.98], P = 0.018) and 1-year mortality (adj.HR per 5% 0.84 [0.78, 0.90], P <0.0001).
Conclusions:
Patients who underwent pLVAD-supported HRPCI exhibited low incidence of PCI-related complications, regardless of baseline LVEF. However, LVEF was associated with 90-day MACCE and 1-year mortality.
