Impella support and acute kidney injury during high‐risk percutaneous coronary intervention: The Global cVAD Renal Protection Study

Abstract

Background: Protection against acute kidney injury (AKI) has been reported with the use of Impella during high-risk percutaneous coronary intervention (HR-PCI). We sought to evaluate this finding by determining the occurrence of AKI during Impellasupported HR-PCI in patients from the Global cVAD Study and compare this incidence with their calculated AKI risk at baseline. Methods and Results:In this prospective, multicenter study, we enrolled 314 consecutive patients. We included 223 patients that underwent nonemergent HR-PCI supported with Impella 2.5 or Impella CP and excluded those requiring hemodialysis prior to HR-PCI (19) and those with insufficient data (72). The primary outcome was AKI postprocedurally at 48 hr versus the predicted risk of AKI according to Mehran risk score. Logistic regression analysis determined predictors of AKI. Overall, 4.9% (11) of Impella-supported patients developed AKI (exclusively stage 1) at 48 hr versus a predicted rate of 21.9%, representing a 77.6% lower AKI rate (p < .0001). In this study, no Impella-supported patients required renal replacement therapy. Estimated glomerular filtration rate (ml/min/1.73 m 2 ) alone predicted AKI (adjusted odds ratio [AOR]: 4.915; 95% confidence intervals [CI]: 1.02-23.53, p = .046), and increasing contrast had insignificant effects on AKI during high-risk PCI (AOR: 1.15; 95% CI: 0.87-1.51, p = .332). In patients not protected from AKI, the postprocedure incidence of AKI was not significantly greater and did not correlate with chronic kidney disease severity.Conclusion: The incidence of AKI was lower during HR-PCI than expected from current risk models. Although further exploration of this finding is warranted, these data support a new protective strategy against AKI during HR-PCI.contrast, hemodynamic support, left ventricular dysfunction, renal protection ABBREVIATIONS: AKI, acute kidney injury; AKIN, acute kidney injury network; CIN, contrast-induced nephropathy; CKD, chronic kidney disease; Cr, creatinine; eGFR, estimated glomerular filtration rate; PCI, percutaneous coronary intervention; pLVAD, percutaneous left ventricular assist device.

Extracorporeal life support system during cardiovascular procedures: Insights from the German Lifebridge registry

“…Interestingly, in the Europella registry no infarctions occurred, while USpella investigators report a rate of 13.4% which is slightly higher than our results (8%) 22,23 . Very recently, Flaherty et al could show in a prospective multi‐center study that ECLS use during high‐risk PCI protected the patients from acute kidney injury (AKI) after observing it in a retrospective single‐center cohort two years earlier 24,25 . Here, the authors report a significantly reduced rate of AKI of only 4.9% as compared to the predicted rate of AKI according to Mehran score of 21.9% 25 .…”

“…Very recently, Flaherty et al could show in a prospective multi‐center study that ECLS use during high‐risk PCI protected the patients from acute kidney injury (AKI) after observing it in a retrospective single‐center cohort two years earlier 24,25 . Here, the authors report a significantly reduced rate of AKI of only 4.9% as compared to the predicted rate of AKI according to Mehran score of 21.9% 25 . In our cohort protected by ECLS, the rate of renal failure, 12%, was slightly higher than in Flaherty's study, but still lower than the described unprotected rate.…”

Practical guide to prevention of contrast‐induced acute kidney injury after percutaneous coronary intervention

“…Hemodynamic support is known to reduce the risk of CI‐AKI, as recently confirmed by Flaherty et al: circulatory support with Impella (Abiomed Inc., Danvers, MA) during high‐risk PCI reduces the incidence of CI‐AKI compared to the predicted risk from Mehran score (4.9 vs. 21.9%, p < .001) 43 …”

The Role of Hemodynamic Support in High-risk Percutaneous Coronary Intervention

“…45,46 PROTECT III is an ongoing, prospective, FDA post-approval study of Impella-supported HR-PCI patients. Between 2017 and 2019, a total of 898 Superior hemodynamic support during HR-PCI 45 Supports longer rotational atherectomy procedures during HR-PCI 48 Improved clinical outcomes up to 90 days after HR-PCI 45,[49][50][51] Extensive revascularization with Impella associated with improved outcomes 53 Protects against in-hospital acute kidney injury 55,56 Improved survival and ejection fraction in the long term 21,[57][58][59] Beneficial in patients with LVEF >35% undergoing HR-PCI 61 In Protect II, Impella provided superior hemodynamic support compared to IABP (maximal decrease in cardiac power of 0.04 ± 0.24 W with Impella versus 0.14 ± 0.27 W with IABP; p=0.001). 45 Only 6% of Impella patients were discharged from the catheterization lab on the device, compared to 37% of IABP patients.…”