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

Simonton, Charles A.; Thompson, Craig A.; Wollmuth, Jason; Morris, D Lynn; Dahle, Thom G.

doi:10.15420/usc.2020.18

Cited by 3 publications

(2 citation statements)

References 55 publications

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“…MCS devices have been used during HR-PCI procedures to achieve more complete revascularization and enhance safety by maintaining hemodynamic stability and tissue perfusion throughout the procedure (11). The intra-aortic balloon pump (IABP) was previously the primarily used MCS device that can increase cardiac output by 0.5-1 L/min (12).…”

Section: Introductionmentioning

confidence: 99%

Predictors of left ventricular ejection fraction in high-risk percutaneous coronary interventions

Panoulas,

Escaned,

Hill

et al. 2024

Front. Cardiovasc. Med.

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Revascularization completeness after percutaneous coronary intervention (PCI) is associated with improved long-term outcomes. Mechanical circulatory support [intra-aortic balloon pump (IABP) or Impella] is used during high-risk PCI (HR-PCI) to enhance peri-procedural safety and achieve more complete revascularization. The relationship between revascularization completeness [post-PCI residual SYNTAX Score (rSS)] and left ventricular ejection fraction (LVEF) in HR-PCI has not been established. We investigated LVEF predictors at 90 days post-PCI with Impella or IABP support. Individual patient data (IPD) were analyzed from PROTECT II (NCT00562016) in the base case. IPD from PROTECT II and RESTORE-EF (NCT04648306) were naïvely pooled in the sensitivity analysis. Using complete cases only, linear regression was used to explore the predictors of LVEF at 90 days post-PCI. Models were refined using stepwise selection based on Akaike Information Criterion and included: treatment group (Impella, IABP), baseline characteristics [age, gender, race, New York Heart Association Functional Classification, LVEF, SYNTAX Score (SS)], and rSS. Impella treatment and higher baseline LVEF were significant predictors of LVEF improvement at 90 days post-PCI (p ≤ 0.05), and a lower rSS contributed to the model (p = 0.082). In the sensitivity analysis, Impella treatment, higher baseline LVEF, and lower rSS were significant predictors of LVEF improvement at 90 days (p ≤ 0.05), and SS pre-PCI contributed to the model (p = 0.070). Higher baseline LVEF, higher SS pre-PCI, lower rSS (i.e. completeness of revascularization), and Impella treatment were predictors of post-PCI LVEF improvement. The findings suggest potential mechanisms of Impella include improving the extent and quality of revascularization, and intraprocedural ventricular unloading.

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Section: Introductionmentioning

confidence: 99%

Predictors of left ventricular ejection fraction in high-risk percutaneous coronary interventions

Panoulas,

Escaned,

Hill

et al. 2024

Front. Cardiovasc. Med.

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show abstract

“… 11 – 13 Conventional risk approaches identify periprocedural and short-term risk from assessments in 3 pillars of risk: 1) cardiovascular risk assessment based on demographic, clinical, and presentation characteristics; 2) high-risk physiologic and hemodynamic subgroups; and 3) anatomic and procedural considerations. 14 However, the conventional approach does not incorporate geriatric syndromes.…”

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confidence: 99%