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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Impact of Mean Blood Pressure Profiles in Percutaneous Left Ventricular Assist Device-Supported High-Risk
Guillaume Bonnet1,2, Karl-Philipp Rommel1,3, Batla Falah1
1Cardiovacular Research Foundation New York NY USA.
Insights
Lower preprocedural blood pressure in patients undergoing high-risk percutaneous coronary intervention with percutaneous left ventricular assist device support was not linked to in-hospital outcomes. However, lower blood pressure was associated with increased 90-day adverse events and 1-year mortality.
Area of Science:
- Cardiology
- Interventional Cardiology
- Hemodynamics
Background:
- Percutaneous left ventricular assist devices (pLVADs) are used to prevent hypotension during high-risk percutaneous coronary intervention (PCI).
- The impact of preprocedural hemodynamic profiles on outcomes in these patients is not well understood.
Purpose of the Study:
- To investigate the association between preprocedural mean blood pressure (MBP) and procedural, in-hospital, and long-term clinical outcomes in patients undergoing high-risk PCI with pLVAD support.
Main Methods:
- Analysis of 1159 patients from the PROTECT III registry (NCT04136392) undergoing pLVAD-supported high-risk PCI.
- Patients were stratified into four preprocedural MBP categories (≤80, >80-90, >90-100, >100 mmHg).
- Comparison of in-hospital outcomes, 90-day major adverse cardiovascular and cerebrovascular events (MACCE), and 1-year mortality between MBP groups.
Main Results:
- Lower preprocedural MBP was associated with baseline anemia, heart failure history, left main disease, and inter-hospital transfer.
- No significant differences in in-hospital or procedural adverse outcomes were observed across MBP categories.
- Rates of 90-day MACCE and 1-year mortality increased progressively with decreasing preprocedural MBP levels.
- The association between lower MBP and increased 1-year mortality remained significant after multivariable adjustment (HR 0.79).
Conclusions:
- Preprocedural hemodynamic status, specifically MBP, did not correlate with in-hospital outcomes in patients undergoing high-risk PCI with pLVAD support.
- Lower preprocedural MBP is a significant predictor of increased 90-day MACCE and 1-year mortality in this patient population.
Background:
Percutaneous left ventricular assist devices are used prophylactically to prevent hypotension during high-risk percutaneous coronary intervention. However, the impact of preprocedural hemodynamic profiles on procedural and clinical outcomes in these patients is unknown.
Methods And Results:
Patients from the central venous access device PROTECT III registry (NCT04136392) were categorized according to preprocedural mean blood pressure (MBP). Procedural and in-hospital outcomes, including hypotensive episodes, need for prolonged percutaneous left ventricular assist device support, and in-hospital death, were compared between groups. We also assessed the relationship between preprocedural MBP and 90-day major adverse cardiovascular and cerebrovascular events, which included all-cause death, myocardial infarction, stroke/transient ischemic attack, and repeat revascularization, as well as with 1-year mortality. A total of 1159 patients underwent percutaneous left ventricular assist device-supported high-risk percutaneous coronary intervention and were stratified into 4 hemodynamic profiles of preprocedural MBP level: MBP>100 mm Hg (n=242), >90 to ≤100 mm Hg (n=264), >80 to ≤90 mm Hg (n=306), and ≤80 mm Hg (n=347). Lower preprocedural MBP was associated with baseline anemia, history of heart failure, left main disease, and transfer from another hospital. In-hospital and procedural adverse outcomes did not differ between the BP categories. However, 90-day major adverse cardiovascular and cerebrovascular events rates and 1-year mortality increased with decreasing baseline BP levels. The association between BP category and 1-year mortality remained significant after adjustment for other factors (hazard ratio [HR], 0.79 [95% CI, 0.71-0.88], P<0.001).
Conclusions:
In a real-world cohort undergoing high-risk percutaneous coronary intervention with percutaneous left ventricular assist device support, there was no association between hemodynamic status and in-hospital outcomes. Lower preprocedural BP was associated with higher rates of 90-day major adverse cardiovascular and cerebrovascular events and 1-year mortality.
Registration:
URL: https://www.clinicaltrials.gov; Unique identifier: NCT04136392.
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