Coronary interventions

New-generation mechanical circulatory support during high-risk PCI: a cross-sectional analysis

EuroIntervention 2019;15:427-433. DOI: 10.4244/EIJ-D-18-01126

Koen Ameloot
Koen Ameloot1, MD; Marcelo B Bastos1, MD; Joost Daemen1, MD, PhD; Jan Schreuder1, MD, PhD; Eric Boersma1, PhD; Felix Zijlstra1, MD, PhD; Nicolas M. Van Mieghem1, MD, PhD
1. Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands

Aims: The aim of the study was to establish the value of new-generation mechanical circulatory support (MCS) devices such as HeartMate PHP, Impella CP and PulseCath iVAC2.

Methods and results: We retrospectively analysed all consecutive elective high-risk PCI procedures performed in the Erasmus Medical Center (2011-2018) in order to compare MCS protected and unprotected patients. The primary endpoint was a composite of procedure-related adverse events including death (<24 hours), cardiac arrest, need for vasopressors, rescue MCS, endotracheal intubation and limb ischaemia with need for surgery. Secondary endpoints included 30-day survival. A total of 198 elective high-risk PCI patients were included (69 [35%] MCS protected, 129 [65%] MCS unprotected). When compared with unprotected patients, MCS protected patients had a significantly worse left ventricular ejection fraction (LVEF) (25±10 vs 33±8%, p<0.01) and higher SYNTAX I score (33±11 vs 24±8, p<0.01). The primary endpoint occurred in 26 (20%) of the unprotected patients and in 6 (9%) of the MCS protected patients (OR 0.38, 95% CI: 0.15-0.97, p=0.04). Patients under 75 years of age, with a SYNTAX I score above 32 and with an LVEF below 30% showed most potential benefit from MCS. Survival during the first 24 hours after the procedure and at 30 days was significantly higher in MCS protected patients (100% vs 95%, p=0.04 at 24 hours, and 98% vs 87%, OR 10.32, 95% CI: 1.34-79.31, p=0.006 at 30 days).

Conclusions: In a consecutive real-world cohort of high-risk PCI patients, protection with new-generation MCS resulted in better procedural outcomes despite worse EF and more complex coronary artery disease at baseline. Larger prospective studies are needed to confirm these findings.

Sign in to read and download the full article

Forgot your password?

No account yet?
Sign up for free!

Create my pcr account

Join us for free and access thousands of articles from EuroIntervention, as well as presentations, videos, cases from

depressed left ventricular functionnstemistable anginaventricular assist device
Coronary interventionsNSTEMIStable CAD
Read next article
Clinical use of intracoronary imaging. Part 2: acute coronary syndromes, ambiguous coronary angiography findings, and guiding interventional decision-making: an expert consensus document of the European Association of Percutaneous Cardiovascular Interventions

Latest news