Comparison of peri and post-procedural complications in patients undergoing revascularisation of coronary artery multivessel disease by coronary artery bypass grafting or protected percutaneous coronary intervention with the Impella 2.5 device

Becher, Tobias; Baumann, Stefan; Eder, Frederik; Perschka, Simon; Loßnitzer, Dirk; Fastner, Christian; Behnes, Michael; Doesch, Christina; Borggrefe, Martin; Akın, İbrahim

doi:10.1177/2048872617717687

Cited by 16 publications

(17 citation statements)

References 32 publications

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“…In these patients, cardiac surgery is often refused. Consequently, these high-risk patients are currently often offered PCI as an alternative to CABG [10,12]. We recently defined a setting for the performance of safe and efficient high-risk interventional (HRI) procedures using an algorithm that incorporates anatomical complexity, comorbidity, and clinical presentation [11].…”

Section: Introductionmentioning

confidence: 99%

Impact of Diabetes Mellitus on Outcomes after High-Risk Interventional Coronary Procedures

Johannsen¹,

Soldat²,

Krueger³

et al. 2020

JCM

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An increasing number of patients with coronary artery disease are at high operative risk due to advanced age, severe comorbidities, complex coronary anatomy, and reduced ejection fraction. Consequently, these high-risk patients are often offered percutaneous coronary intervention (PCI) as an alternative to coronary artery bypass grafting (CABG). We aimed to investigate the outcome of patients with diabetes mellitus (DM) undergoing high-risk PCI. We analyzed consecutive patients undergoing high-risk PCI (period 01/2016–08/2018). In-hospital major adverse cardiac and cerebrovascular events (MACCEs), defined as in-hospital stroke, myocardial infarction and death, and the one-year incidence of death from any cause were assessed in patients with and without DM. There were 276 patients (age 70 years, 74% male) who underwent high-risk PCI. Eighty-six patients (31%) presented with DM (insulin-dependent DM: n = 24; non-insulin-dependent DM: n = 62). In-hospital MACCEs occurred in 9 patients (3%) with a non-significant higher rate in patients with DM (n = 5/86, 6% vs. n = 4/190 2%; p = 0.24). In patients without DM, the survival rate was insignificantly higher than in patients with DM (93.6% vs. 87.1%; p = 0.07). One-year survival was not significantly different in DM patients with more complex coronary artery disease (SYNTAX I-score ≤ 22: 89.3% vs. > 22: 84.5%; p = 0.51). In selected high-risk patients undergoing high-risk PCI, DM was not associated with an increased incidence of in-hospital MACCEs or a decreased one-year survival rate.

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Section: Introductionmentioning

confidence: 99%

Impact of Diabetes Mellitus on Outcomes after High-Risk Interventional Coronary Procedures

Johannsen¹,

Soldat²,

Krueger³

et al. 2020

JCM

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“…Similarly, in another trial, complex multivessel CAD patients who underwent protected PCI with the Impella 2.5 device experienced similar in-hospital major adverse cardiac and cerebrovascular event rates when compared to CABG. However, patients undergoing CABG experienced significantly more peri-procedural additional adverse events (28.6 vs. 3.8%; p < .05) 3. In our cohort, women had higher rates of renal insufficiency than men at baseline and despite this, the clinical outcome including worsening renal failure or renal failure requiring dialysis was similar in females and males.…”

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confidence: 57%

“…males in the treatment of high-risk PCI from the cVAD Registry are 1 ; symptomatic females with complex high-risk coronary disease have higher comorbidities and are at greater risk of death with CABG as indicated by STS score compared to males 2. Females were equally likely as males to survive to hospital discharge after high-risk PCI with MCS support despite having higher STS mortality risk scores 3. Myocardial infarction, stroke, AKI, repeat revascularization, and vascular complications rates were also similar in both sexes 4.…”

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confidence: 89%

“…Indeed, protected PCI using percutaneous mechanical circulatory support has been demonstrated to be equally safe and effective as coronary artery bypass grafting. 3 Current guidelines recommend elective insertion of hemodynamic support devices in selected patients undergoing high-risk coronary interventions. 2 Further, the elective use of Impella 2.5 and Impella CP (Abiomed Inc., Danvers, MA) devices in patients having high-risk PCI have been shown to be safe and effective, and also provide a left ventricular unloading effect.…”

Section: Introductionmentioning

confidence: 99%

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Sex‐related difference in the use of percutaneous left ventricular assist device in patients undergoing complex high‐risk percutaneous coronary intervention: Insight from the cVAD registry

Alraies

Kaki

Kajy

et al. 2019

Cathet Cardio Intervent

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Objective To assess the in‐hospital and short‐term outcome differences between males and females who underwent high‐risk PCI with mechanical circulatory support (MCS). Background Sex differences have been noted in several percutaneous coronary intervention (PCI) series with females less likely to be referred for PCI due increased risk of adverse events. However, data on sex differences in utilization and outcomes of high‐risk PCI with MCS is scarce. Methods Using the cVAD Registry, we identified 1,053 high‐risk patients who underwent PCI with MCS using Impella 2.5 or Impella CP. Patients with cardiogenic shock were excluded. A total of 792 (75.21%) males and 261 (24.79%) females were included in the analysis with median follow‐up of 81.5 days. Results Females were more likely to be African American, older (72.05 ± 11.66 vs. 68.87 ± 11.17, p < .001), have a higher prevalence of diabetes (59.30 vs. 49.04%, p = .005), renal insufficiency (35.41 vs. 27.39%, p = .018), and peripheral vascular disease (31.89 vs. 25.39%, p of .05). Women had a higher mean STS score (8.21 ± 8.21 vs. 5.04 ± 5.97, p < .001) and lower cardiac output on presentation (3.64 ± 1.30 vs. 4.63 ± 1.49, p < .001). Although women had more comorbidities, there was no difference in in‐hospital mortality, stroke, MI or need for recurrent revascularization compared to males. Females were more likely to have multivessel revascularization than males. Ejection fraction improved in both males and females at the time of discharge (26.59 to 31.40% and 30.75 to 36.05%, respectively, p < .0001). However, females had higher rate of bleeding requiring transfusion compared with males (9.58 vs. 5.30%, p = .019). Conclusion Female patients undergoing high PCI were older and had more comorbidities but had similar outcomes compared to males.

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“…We have previously reported that patients with MVD undergoing protected PCI with the Impella 2.5 device experience similar in-hospital outcomes when compared to coronary artery bypass grafting. [ 16 ] However, there are currently no data available comparing in-hospital and long-term outcomes of patients undergoing Impella 2.5-supported PCI with unprotected PCI.…”

Section: Introductionmentioning

confidence: 99%

Unprotected versus protected high-risk percutaneous coronary intervention with the Impella 2.5 in patients with multivessel disease and severely reduced left ventricular function

et al. 2018

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Selecting a revascularization strategy in patients with multivessel disease (MVD) and severely reduced left ventricular ejection fraction (LVEF) remains a challenge. PCI with Impella 2.5 may facilitate high-risk PCI, however long-term results comparing unprotected versus protected PCI are currently unknown. We sought to evaluate the outcome of patients undergoing protected compared to unprotected percutaneous coronary intervention (PCI) in the setting of MVD and severely reduced LVEF.We included patients with MVD and severely reduced LVEF (≤35%) in this retrospective, single-centre study. Patients that underwent unprotected PCI before the start of a dedicated protected PCI program with Impella 2.5 were compared to patients that were treated with protected PCI after the start of the program. The primary endpoint was defined as major adverse cardiac and cerebrovascular events (MACCE) during a 1-year follow-up. The secondary endpoints consisted of in-hospital MACCE and adverse events.A total of 61 patients (mean age 70.7 ± 10.9 years, 83.6% male) were included in our study, of which 28 (45.9%) underwent protected PCI. The primary endpoint was reached by 26.7% and did not differ between groups (P = .90). In-hospital MACCE (P = 1.00) and in-hospital adverse events (P = .12) also demonstrated no significant differences. Multivariate logistic regression identified procedural success defined as complete revascularization and absence of in-hospital major clinical complications as protective parameter for MACCE (OR 0.17, 95% CI 0.04–0.70, P = .02).Patients with MVD and severely depressed LVEF undergoing protected PCI with Impella 2.5 demonstrate similar in-hospital and one-year outcomes compared to unprotected PCI.

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Comparison of peri and post-procedural complications in patients undergoing revascularisation of coronary artery multivessel disease by coronary artery bypass grafting or protected percutaneous coronary intervention with the Impella 2.5 device

Cited by 16 publications

References 32 publications

Impact of Diabetes Mellitus on Outcomes after High-Risk Interventional Coronary Procedures

Impact of Diabetes Mellitus on Outcomes after High-Risk Interventional Coronary Procedures

Sex‐related difference in the use of percutaneous left ventricular assist device in patients undergoing complex high‐risk percutaneous coronary intervention: Insight from the cVAD registry

Unprotected versus protected high-risk percutaneous coronary intervention with the Impella 2.5 in patients with multivessel disease and severely reduced left ventricular function

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