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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
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Change in left ventricular function and outcomes following high-risk percutaneous coronary intervention with

Serdar Farhan1, Michael Freilich2, Gennaro Giustino1

  • 1The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States.

Frontiers in Cardiovascular Medicine
|July 22, 2024
PubMed

Insights

High-risk percutaneous coronary interventions (HRPCI) supported by Impella can improve left ventricular ejection fraction (LVEF) in over 40% of patients. However, LVEF improvement did not significantly alter 1-year adverse cardiovascular outcomes in this study.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • High-risk percutaneous coronary interventions (HRPCI) offer a treatment option for patients with coronary artery disease and reduced left ventricular ejection fraction (LVEF).
  • The impact of HRPCI on LVEF improvement and subsequent clinical outcomes remains incompletely understood.

Purpose of the Study:

  • To determine the incidence and predictors of LVEF improvement after Impella-guided HRPCI.
  • To compare clinical outcomes between patients with and without LVEF improvement post-intervention.

Main Methods:

  • A retrospective analysis of consecutive patients undergoing Impella-guided HRPCI from a single-center registry.
  • LVEF improvement was defined as an absolute increase of ≥10% at ≥30 days post-intervention.
  • The primary outcome was a composite of all-cause death, myocardial infarction, or target vessel revascularization within 1 year.

Main Results:

  • Over 40% of patients (70/161) achieved LVEF improvement (25.1% to 33.3%).
  • Factors associated with no LVEF improvement included prior myocardial infarction, Q-waves on ECG, and higher SYNTAX scores.
  • One-year adverse cardiovascular event rates were similar in patients with and without LVEF improvement (34.9% vs. 38.3%).

Conclusions:

  • LVEF improvement is achievable in a significant proportion of patients undergoing Impella-guided HRPCI.
  • History of MI, ECG Q-waves, and higher SYNTAX scores are associated with a lack of LVEF improvement.
  • Further prospective studies are necessary to clarify the long-term clinical significance of LVEF improvement after HRPCI.
Abstract

Keywords:
ImpellaSYNTAX scorehigh-risk percutaneous coronary interventionsleft ventricular ejection fractionmechanical circulatory devices

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