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Lower AKI Risk and Higher Survival With Microaxial Flow Pump Support During Elective PCI: A Propensity Score-Matched
Elric Zweck1, Andrew Shaw2, Amin Polzin1
1Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
Background:
Acute kidney injury (AKI) is associated with worse outcomes after percutaneous coronary intervention (PCI). Previous, smaller studies suggested nephroprotective effects of micro-axial flow pump (mAFP) during PCI. This study aimed to compare renal outcomes of high-risk PCI with mAFP or intraaortic balloon pump (IABP) support.
Aims:
This study aimed to compare renal outcomes of high-risk PCI with mAFP or intraaortic balloon pump (IABP) support.
Methods:
Patients undergoing elective, non-emergent, high-risk PCI with mAFP or IABP between 2017 and 2025 were retrospectively included from the TRUVETA database, which covers 120 million US patients. Patients with mAFP or IABP support were propensity score-matched for AKI risk, adjusting for demographic and clinical characteristics including baseline kidney function, AKI risk, and comorbidities.
Results:
Of 24,645 patients undergoing PCI with mechanical circulatory support, 7872 elective high-risk PCI cases were identified: 2349 (29.8%) with IABP and 5523 (70.2%) with mAFP support. Prior to matching, patients receiving mAFP support were older and had more comorbidities compared to IABP. After exclusion of patients with missing baseline eGFR, propensity score matching was performed in 4666 patients (2333 per group) resulting in comparable baseline characteristics of the two groups. After matching, the risk of AKI (18.9% vs. 23.2%) and all-cause mortality (15.9% vs. 20.7%) was lower in mAFP-supported patients compared to IABP (all p < 0.001). Bleeding, stroke, and RRT incidences were comparable between groups. There was no interaction between baseline kidney function and lower AKI risk with mAFP.
Conclusion:
This propensity score-matched observational study indicates that the use of mAFP in the setting of elective high-risk PCI is associated with a lower risk of AKI and higher survival compared with IABP.
Insights
Micro-axial flow pump (mAFP) support during high-risk percutaneous coronary intervention (PCI) is linked to reduced acute kidney injury (AKI) and improved survival compared to intraaortic balloon pump (IABP). This finding offers valuable insights for optimizing patient outcomes in PCI procedures.
Area of Science:
- Cardiology
- Nephrology
- Medical Devices
Background:
- Acute kidney injury (AKI) is a significant complication following percutaneous coronary intervention (PCI), leading to poorer patient outcomes.
- Previous research suggested potential nephroprotective benefits of micro-axial flow pumps (mAFP) during PCI, warranting further investigation.
- High-risk PCI procedures necessitate effective strategies to mitigate renal complications.
Purpose of the Study:
- To compare the renal outcomes of high-risk PCI when supported by mAFP versus intraaortic balloon pump (IABP).
- To evaluate the impact of mAFP and IABP on acute kidney injury (AKI) incidence in patients undergoing high-risk PCI.
- To assess differences in all-cause mortality and other adverse events between mAFP and IABP support groups.
Main Methods:
- A retrospective analysis of patients undergoing elective, high-risk PCI with mAFP or IABP support between 2017 and 2025 was conducted using the TRUVETA database.
- Propensity score matching was employed to balance baseline characteristics, including AKI risk, kidney function, and comorbidities, between the mAFP and IABP groups.
- A total of 4666 patients (2333 per group) were included after propensity score matching, ensuring comparable cohorts for analysis.
Main Results:
- The incidence of AKI was significantly lower in the mAFP group (18.9%) compared to the IABP group (23.2%) (p < 0.001).
- All-cause mortality was also reduced in patients supported by mAFP (15.9%) versus IABP (20.7%) (p < 0.001).
- Rates of bleeding, stroke, and renal replacement therapy (RRT) were comparable between the two support devices, with no interaction observed between baseline kidney function and the reduced AKI risk with mAFP.
Conclusions:
- The use of mAFP during elective high-risk PCI is associated with a reduced risk of AKI and improved survival rates when compared to IABP support.
- These findings suggest that mAFP may be a preferred mechanical circulatory support device for optimizing renal outcomes in high-risk PCI patients.
- The study highlights the importance of device selection in mitigating complications and improving prognoses in complex PCI procedures.
