This large multicenter registry supports the safety, feasibility, and potential usefulness of hemodynamic support with Impella 2.5 in high-risk PCI.

Endurance training in rats after small infarction, whether started early or late after left coronary artery ligation, was well tolerated without changes in LV volume, shape, hemodynamics, and long-term survival. Endurance training in rats with large infarction decreased overall survival (P < .0001). In survivors from late exercise, training caused aggravation of global LV dilation without additional shape changes. Endurance training after large infarction caused aggravation of remodeling to a degree that was not compatible with life in 27% of the rats with late exercise and in 48% with early exercise after coronary artery ligation, despite similar exercise. This was explained by extensive remodeling that was most pronounced in nonsurvivors from early exercise. In these rats, severe global LV dilation, distortion of LV shape, scar thinning, and a paradoxic reduction of septal thickness, ie, mismatch of infarcted and noninfarcted myocardia, were observed.

TTC afflicts mainly women and presents clinically as an ACS in 87 %. Hospital mortality is low with symptomatic therapy.

Background Patients with complex or high risk coronary lesions, due to extensive and diffuse multivessel, left main or last remaining coronary artery disease are increasingly being treated with percutaneous coronary intervention (PCI). As peri-procedural hemodynamic compromise and complications may occur rapidly, many of these high-risk procedures are being performed with mechanical cardiac assistance, particularly in patients with poor left ventricular (LV) function. The Impella LP2.5, a novel percutaneous implantable LVAD able to provide flow up to 2.5 L/min, may be a superior alternative to the traditionally used IABP. Methods We studied safety and feasibility of LV support with the Impella LP2.5 in 144 high-risk PCI patients. All patients were enrolled in the Europella registry, a prospective multicenter registry comprising 10 high volume tertiary PCI centers in Europe. Results Patients were old (62% >70 years), 53% had previous myocardial infarction, 54% had a LV ejection fraction ≤30% and the prevalence of co-morbid conditions was high. Mean EuroSCORE was 8.2 (SD 3.4) and 43% of the patients were refused for CABG. PCI was considered high risk due to left main, last remaining and multivessel coronary artery disease, and low LV function respectively in 53%, 17%, 81% and 35% of the cases. The mean assist time was 1 hour and 28 minutes (SD 51min). There were no intra-procedural major adverse cardiac and cerebral events. In-hospital and 30-day mortality were 4.7% and 5.5%. Rates of myocardial infarction, stroke, bleeding requiring transfusion/surgery and vascular complications at 30 days were respectively 0%, 0.7%, 1.4% and 4.0% Conclusions The safety and feasibility findings of Impella LP2.5 are encouraging. Our study, supports the potential usefulness of hemodynamic support with Impella LP2.5 to prevent intra-procedural major adverse events and hemodynamic compromise in high-risk PCI.

Magnetic guided PCI is useful in selected patients. In our experience, success is less likely in evidence of a subtotal occlusion.