对于非突发性高风险皮肤冠状动脉干预,Impella与非Impella对比
Pavan Reddy1, Ilan Merdler1, Cheng Zhang1
1Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
The American journal of cardiology
|January 25, 2025
概括
机械循环支持 (Impella) 并没有改善高风险皮肤冠状动脉干预 (HR-PCI) 患者的住院结果. 虽然没有Impella,90天主要心脏不良事件的发生率较低,但在等待进一步的RCT数据之前,不支持常规使用.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 医疗器械 医疗器械
背景情况:
- 在高风险皮肤冠状动脉干预 (HR-PCI) 中,Impella机械循环支持 (MCS) 的疗效仍然不确定,尽管正在进行的试验如PROTECT IV.
- 之前的注册表数据 (PROTECT III) 表明与历史对照 (PROTECT II) 相比有好处,但与当代非Impella支持的HR-PCI队列的直接比较缺乏.
研究的目的:
- 以回顾性地比较HR-PCI患者的住院和90天治疗结果与那些没有接受Impella支持的人,使用PROTECT III试验中相同的纳入标准.
- 评估Impella在精心挑选的HR-PCI群体中使用的安全性和有效性.
- 为正在进行的关于Impella在非紧急,高风险的PCI程序中的常规使用的辩论提供信息.
主要方法:
- 在一个机构对符合PROTECT III纳入标准的患者进行了回顾性分析 (LVEF<35%的左主/最后剩余血管未受保护或LVEF<30%的多血管PCI).
- 非Impella支持的队列 (NonIMP) 与Impella支持的 (IMP) PROTECT III注册表队列的公布数据的比较.
- 逆倾向权重 (IPW) 用于平衡非IMP和IMP组之间的基线特征;共同主要的结局是住院和90天主要不良心脏事件 (MACE).
主要成果:
- 在IPW之后,非IMP组年龄较大,患上之前冠状动脉旁路移植的患病率更高,但两组不受保护的左主干预率相似 (43%).
- 在非IMP (3.0%) 和IMP (4.8%) 组 (p=0.403) 中,住院MACE的发生率相似.
- 在90天后,MACE在非IMP组 (7.5%) 与IMP组 (13.8%) (p=0.033) 相比显著降低. 在非IMP组中,急性损伤更频繁 (10.5%对5.4%,p=0.023),而血管并发症,出血和输血率相似.
结论:
- 在符合PROTECT III标准的HR-PCI患者中,与Impella支持的PROTECT III队列相比,一个机构非Impella队列表现出类似的住院MACE,但90天的MACE较低.
- 在使用Impella时没有观察到术前的危害,但结果不支持它在这个患者群体中的常规应用.
- 谨慎的患者选择至关重要,直到大型随机对照试验在更广泛的HR-PCI人群中显示出Impella的明显益处.
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