Propensity matched analysis of single access technique for Impella-assisted unprotected left main percutaneous coronary intervention

Authors

Raef Fadel, Henry Ford HealthFollow
Benjamin Hofeld, Henry Ford Health
Herbert D. Aronow, Henry Ford HealthFollow
Ahmad Jabri, Henry Ford HealthFollow
Pedro Engel Gonzalez, Henry Ford HealthFollow
Gerald C. Koenig, Henry Ford HealthFollow
Muhammad Memon, Henry Ford HealthFollow
Mohammad Alqarqaz, Henry Ford HealthFollow
Khaldoon Alaswad, Henry Ford HealthFollow
Brittany S. Fuller, Henry Ford HealthFollow
Asaad Nakhle, Henry Ford HealthFollow
Vikas Aggarwal, Henry Ford HealthFollow
Brian O’Neill, Henry Ford HealthFollow
Tiberio Frisoli, Henry Ford HealthFollow
Mir B. Basir, Henry Ford HealthFollow
Henry Kim, Henry Ford HealthFollow
William O'Neill, Henry Ford HealthFollow
Pedro Villablanca, Henry Ford HealthFollow

Recommended Citation

Fadel RA, Hofeld B, Aronow HD, Jabri A, Engel P, Koenig G, Memon M, Alqarqaz M, Alaswad K, Fuller B, Nakhle A, Aggarwal V, O'Neill B, Frisoli T, Basir MB, Kim H, O'Neill W, and Villablanca P. Propensity matched analysis of single access technique for Impella-assisted unprotected left main percutaneous coronary intervention. Cardiovasc Revasc Med 2025.

Document Type

Article

Publication Date

5-22-2025

Publication Title

Cardiovasc Revasc Med

Abstract

BACKGROUND: The single access for high-risk percutaneous coronary intervention (SHiPCI) technique is an intriguing alternative to traditional dual access Impella-assisted PCI, potentially reducing access-site complications. Current data is limited to retrospective case studies.

OBJECTIVES: To analyze procedural complications and clinical outcomes of SHiPCI.

METHODS: This single-center retrospective observational study evaluated consecutively admitted patients undergoing high-risk unprotected left main PCI (UPLM-PCI) from 2018 through 2023. Patients were grouped according to index strategy of single or dual access Impella-assisted UPLM-PCI, and propensity score matching without replacement was used to match patients 1:1. The primary outcome was a composite of all-cause in-hospital mortality, major bleeding, vascular access site complications, and blood transfusion.

RESULTS: Six-hundred patients underwent UPLM-PCI during the study period, and one hundred patients were matched (50 patients per group). There were no significant differences in baseline characteristics between the two groups. Up-front balloon tamponade assistance was higher in the dual access group (14 % vs 4.0 %, p = 0.027), and rate of successful hemostasis post-closure was lower (82 % vs 100 %, p = 0.001). The primary composite outcome occurred in 7 patients (14 %) in the single access group, compared to 16 patients (32 %) in the dual access group (p = 0.033). Patients in the dual-access group had higher rates of major bleeding (17 % vs 2 %, p = 0.014).

CONCLUSIONS: SHiPCI compared to standard dual access for Impella-assisted UPLM-PCI demonstrated a lower rate lower rate of the composite outcome, driven primarily by a lower rate of major bleeding. Prospective randomized controlled trials are needed to delineate the efficacy and safety of SHiPCI.

PubMed ID

40436725

ePublication

ePub ahead of print