The use of mechanical circulatory support in elective high-risk percutaneous coronary interventions: a...

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Devices

Background:

• Percutaneous coronary intervention (PCI) is increasingly performed in high-risk patients.
• Mechanical circulatory support (MCS) devices are used to mitigate risks during high-risk PCI (HR-PCI).
• Common MCS devices include intra-aortic balloon pump (IABP), veno-arterial extracorporeal membrane oxygenation (V-A ECMO), and Impella.

Purpose of the Study:

• To review clinical evidence for MCS devices in HR-PCI.
• To explore mechanisms of improved outcomes with MCS in HR-PCI.
• To propose a novel algorithm for identifying suitable candidates for MCS-assisted HR-PCI.

Main Methods:

• Review of contemporary medical literature on MCS devices in HR-PCI.
• Analysis of clinical outcomes associated with IABP, V-A ECMO, and Impella.
• Development of a predictive algorithm for MCS utilization in HR-PCI.

Main Results:

• IABP use has decreased due to lack of demonstrated benefit in HR-PCI and cardiogenic shock.
• V-A ECMO shows low major adverse cardiac and cerebrovascular events (MACCEs) but increased risks of acute kidney injury and transfusion.
• Impella use has seen declining MACCE rates with improved operator experience, though mortality benefits require further investigation via randomized trials.

Conclusions:

• Current evidence for IABP in HR-PCI is limited.
• V-A ECMO and Impella present distinct risk-benefit profiles in HR-PCI.
• A new algorithm combining anatomical, comorbidity, and clinical factors is proposed to optimize MCS selection for HR-PCI.