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71 Outcome in patients undergoing high-risk pci using impella circulatory support - 10 year experience
  1. Vincenzo Vetrugno,
  2. Muhammad Waqas,
  3. Kulwinder Sandhu,
  4. Anthony Mechery,
  5. M. Adnan Nadir,
  6. Sudhakar George,
  7. Alexander Zaphiriou,
  8. Sern Lim,
  9. Peter Ludman,
  10. Sagar Doshi,
  11. Jonathan Townend,
  12. sohail khan
  1. Queen Elizabeth Hospital - Birmingham

Abstract

Introduction The use of Impella in the setting of high-risk percutaneous coronary intervention (PCI) has been introduced in clinical practice in the last few years in selected hospitals, giving a chance for revascularization to a sensible number of patients who are usually unsuitable for cardiac surgery due to high risks. In addition, some of these patients present pre-procedural cardiogenic shock, further increasing the rate of morbidity and mortality. Our purpose was to assess outcome of patients undergoing Impella-assisted high-risk PCI in our 10 year experience and to assess possible predictors of adverse events.

Methods From May 2008 to September 2018 patients undergoing Impella-assisted high-risk PCI were enrolled. Clinical, laboratory, echocardiographic, angiographic and procedural data were collected. Coronary artery disease burden was graded using the British Cardiovascular Intervention Society Jeopardy Score (BCIS-JS). In-hospital MACCE were recorded. During routine follow-up visits data including MACCE, hospital admissions for heart failure, Canadian Cardiovascular Society (CCS) angina grade and New York Heart Association (NYHA) functional class were recorded. Long-term survival Kaplan Meier analysis was performed according to national registry death data.

Results A total of 80 consecutive patients were enrolled (71.2±13.7 years, male gender 73.8%), 21 (26.3%) presenting with stable angina, 53 (66.3%) with NSTE-ACS and 6 (7.5%) with STEMI. 67 (83.8%) of them showed multivessel disease, 42 (52.5%) unprotected left main disease, 47 (58.8%) severe left ventricle systolic dysfunction (LVEF<30%), 10 (12.5%) pre-procedural cardiogenic shock. Median BCIS-JS was 10 [8,00; 12,00]. In-hospital MACCE occurred in 16 (20%) patients with death in 15 (18.8%). Median time to first follow-up visit for survivors was 105 (64.5; 282.0) days: at this time 11 (13.8%) patients had MACCE, 3 (3.8%) had hospital admissions for heart failure, median CCS was 0.00 (0.00; 0.00) and median NYHA was 1.00 (1.00; 2.00). Mean survival time (procedure to death, months) was 21 months (C.I. 14.4 - 29.0). Multivariate logistic regression analysis for possible predictors of in-hospital MACCE was performed including the variables showing a p value <0.100 at univariate analysis, i.e. pre-procedural cardiogenic shock [OR 9.00, C.I. (2.1–37.6), p=0.003] and CK peak [OR 1.00, C.I. (1.0–1.0), p=0.051]. Pre-procedural cardiogenic shock was the only predictor [OR 7.058, C.I. (1.2–40.6), p=0.029] of in-hospital MACCE. No significant predictors of MACCE at follow-up were found at logistic regression analysis.

Conclusion In our 10 year experience of Impella-assisted high-risk PCI, 20% patients had in-hospital MACCE and mean survival was 21 months. At follow up, MACCE rate was less than 4% and both angina and heart failure symptoms were well controlled. Pre-procedural cardiogenic shock was the only predictor of in-hospital MACCE.

Conflict of Interest No conflict of interest

  • Impella
  • High-risk PCI
  • Outcome

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