Mechanical Circulatory Support Prior to Elective High-Risk Percutaneous Coronary Intervention
Mawri S, Dabbagh M, Basir M, Voeltz M, Khandelwal A, Koenig G, Alqarqaz M, O'Neill W, Zaidan M, Alaswad K. Mechanical Circulatory Support Prior to Elective High-Risk Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2019; 12(4):S15.
JACC Cardiovasc Interv
Introduction: High-risk percutaneous coronary intervention (HRPCI) carries an elevated mortality risk, for which mechanical circulatory support (MCS) is often required. Severe left ventricular (LV) impairment was the primary risk surrogate for HRPCI defined by the two main prospective randomized trials on MCS in elective HRPCI – the BCIS and Protect II. The BCIS investigators also included a jeopardy score > 8/12, while Protect II investigators included presence of a last patent coronary vessel as inclusion criteria. In this study, we sought to determine the clinical outcomes of patients undergoing elective HRPCI with upfront MCS placement at our institution according to whether or not they met inclusion criteria for BCIS or Protect II trials. Methods: We retrospectively reviewed a total of 47 patients between September 2014 and June 2017 who underwent elective HRPCI with upfront use of MCS at Henry Ford Hospital’s cardiac catheterization laboratory. We excluded HRPCI cases performed in patients presenting with acute coronary syndrome and those with intra-procedurally initiated MCS. Comprehensive demographic, laboratory, procedural and clinical outcome data were obtained and analyzed among patients who met and did not meet BCIS and Protect II trials. Results: Mean age was 71.0 ± 9.2 years, 81% males, with mean ejection fraction (EF) of 40.5% ± 16%. MCS placement was successful in all patients. HRPCI definition according to BCIS criteria was met in 33 patients (70.2%) and according to Protect II trial criteria in 14 patients (29.8%). Compared to those who did not meet BCIS criteria, those who met BCIS criteria were significantly older and had significantly higher risk scores. Compared to those who did not meet Protect II trial criteria, those who met criteria had significantly lower mean EF (46.8% + 14.8% vs 26.6% + 7.4%, p = 0.0001) with similar risk scores. There were no statistically significant differences with regard to in-hospital mortality, myocardial infarction, MACCE, bleeding events, access-site complications and acute kidney injury rates among patients who met versus did not meet BCIS criteria as well as among patients who met versus did not meet Protect II criteria. However, there was more incidence of adverse events among patients who met BCIS criteria and did not meet Protect II criteria. Conclusion: Preemptive MCS appears feasible and overall safe in patients undergoing PCI deemed to be high risk even if not meeting BCIS or Protect II trial definitions; however, larger and more powered studies are needed to validate these findings.