Journal Article

Impact of Hemodynamic Support on Outcome in Patients Undergoing High-Risk Percutaneous Coronary Intervention

Shamekhi, Jasmin, Pütz, Andrea, Welz, Armin, Sinning, Jan-Malte, Fimmers, Rolf, Werner, Nikos, Tiyerili, Vedat, Grube, Eberhard, Mellert, Fritz, Nickenig, Georg, Zimmer, Sebastian

2019

Overview

The use of left-ventricular (LV) hemodynamic support might facilitate high-risk percutaneous coronary interventions (PCI) in patients with complex coronary artery disease. The impact on outcome is a matter of ongoing debate. We assessed the outcome of high-risk patients who underwent protected PCI in comparison to patients who underwent unprotected high-risk PCI. One hundred and thirty nine patients underwent nonemergent high-risk PCI; 24 (17%) patients underwent protected PCI. To address selection bias, we performed a propensity score matched subanalysis. The primary end point was the occurrence of a major adverse cardiac event during the first year. Patients with protected PCI had a higher logistic EuroSCORE (logES) (protected PCI: 19% vs unprotected PCI: 12%; p = 0.01), a higher SYNTAX score (45 vs 36, p = 0.07), and significantly more often reduced LV function (40% vs 55%; p < 0.001). In protected PCI patients, complete revascularization was more often achieved (87% vs 58%, p = 0.007) without the occurrence of death at 30 days of follow-up (0% vs 4%, p = 0.31). After propensity score matching, patients who underwent protected PCI had a similar 1-year major adverse cardiac event rate compared with patients who underwent unprotected PCI (21% vs 17%, p = 0.67), despite significantly higher procedural complexity for example, more often complex left main bifurcation lesions (71% vs 29%; p = 0.004). In conclusion, 1-year outcome of patients who underwent protected PCI was not different from that in patients with less complex procedures without hemodynamic support, despite more complex coronary anatomy, a higher comorbidity burden, and more often reduced LV function.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Aged / Aged, 80 and over / Angioplasty / Bifurcations / Cardiology / Cardiovascular disease / Complexity / Coronary artery / Coronary artery disease / Coronary Artery Disease - complications / Coronary Artery Disease - surgery / Coronary vessels / Female / Heart attacks / Heart diseases / Heart rate / Heart-Assist Devices / Hemodynamics / Humans / Intervention / Kidneys / Lesions / Male / Medical imaging / Middle Aged / Mortality / Patient Selection / Patients / Percutaneous Coronary Intervention / Propensity Score / Retrospective Studies / Risk / Risk Factors / Risk groups / Stents / Treatment Outcome / Ventricle / Ventricular Dysfunction, Left - complications / Ventricular Dysfunction, Left - therapy