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Mid-Term Efficacy and Safety of Mechanical Circulatory Support in High-Risk Elective Chronic Total Occlusion
Tiantong Yu1, Shuai Zhao1,2, Bohui Zhang1,3
1Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China.
Insights
Percutaneous mechanical circulatory support (MCS) improves technical success and complete revascularization during high-risk chronic total occlusion percutaneous coronary intervention (PCI). However, it increases in-hospital complications without affecting 1-year major adverse cardiac events.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Devices
Background:
- High-risk chronic total occlusion (CTO) percutaneous coronary intervention (PCI) presents significant challenges.
- Percutaneous mechanical circulatory support (MCS) devices are increasingly used to manage complex PCI procedures.
Purpose of the Study:
- To evaluate the early and 1-year outcomes of MCS use in patients undergoing high-risk CTO-PCI.
- To compare the efficacy and safety of CTO-PCI with and without MCS support.
Main Methods:
- Prospective registry cohort study comparing patients with and without MCS support during elective CTO-PCI.
- Primary endpoint: major adverse cardiac events (MACE) at 1-year follow-up.
- Propensity score matching (PSM) was used to balance baseline characteristics between groups.
Main Results:
- The MCS group had lower LVEF and higher prevalence of multi-vessel CTO.
- MCS use was associated with higher technical success (95.62% vs 87.59%) and complete revascularization rates (89.05% vs 66.42%).
- No significant difference in 1-year MACE rates was observed between groups, but in-hospital MACE and device-related complications were higher with MCS.
Conclusions:
- MCS-supported CTO-PCI enhances procedural success, particularly technical success and complete revascularization.
- While MCS does not increase 1-year MACE, it is linked to higher in-hospital MACE and device-related complications.
- The findings suggest a trade-off between procedural benefits and early safety concerns with MCS in high-risk CTO-PCI.
Background And Aims:
The present study aimed to evaluate the early and 1-year outcomes of using percutaneous mechanical circulatory support (MCS) devices in patients undergoing high-risk chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
Methods:
We conducted a prospective registry cohort study that enrolled patients undergoing high-risk elective CTO-PCI with MCS device support and patients without MCS device support. The primary endpoint was major adverse cardiac events (MACE) at 1-year follow-up.
Results:
A total of 2349 patients were enrolled, comprising 151 in the MCS group and 2198 in the non-MCS group. Compared with the non-MCS group, the MCS group exhibited a lower left ventricular ejection fraction (LVEF) (41.6 ± 10.4% vs. 50.4 ± 8.0%, p < 0.001) and a higher prevalence of two-vessel CTO (30.5% vs. 18.7%, p < 0.001) and three-vessel CTO (5.3% vs. 1.4%, p < 0.001). After propensity score matching (PSM), 137 patients in each group with comparable propensity scores were included for analysis. The cohort had a mean age of 65.97 ± 10.00 years, with 83.94% male participants. The most common MCS devices were IABP alone (66.42%), followed by ECMO + IABP (26.28%) and ECMO alone (7.30%). The MCS group demonstrated significantly higher technical success rates than the non-MCS group (95.62% vs. 87.59%, p = 0.027) but comparable procedural success rates (86.13% vs. 83.94%, p = 0.611). Complete revascularization rates were significantly higher in the MCS group (89.05% vs. 66.42%, p < 0.001). No differences occurred in 1-year MACE incidence or its components between groups, and MCS device use showed no correlation with 1-year MACE risk.
Conclusions:
MCS-supported CTO-PCI improves technical success rates and complete revascularization achievement rates during the index procedure. However, MCS is associated with a significantly higher incidence of in-hospital MACE and device-related complications, despite showing no significant difference in 1-year MACE rates compared to conventional CTO-PCI.
