Role of hemodynamic support in high risk pci patients with left ventricular ejection fraction ef >35%
Alaswad K, Khandelwal A, Schreiber T, Lombardi W, O'Neill W. Role of hemodynamic support in high risk pci patients with left ventricular ejection fraction ef >35%. Catheter Cardiovasc Interv. 2017;89:S45-S46.
Catheter Cardiovasc Interv
Background: Impella mechanical circulatory support (IMCS) (Abiomed, Danville, MA) has been shown to improve complex PCI outcome in patients with reduced leftventricular ejection fraction (LVEF). The outcomes of IMCS during PCI in patients with LVEF>35% is not known. Methods: We examined the cVAD registry to determine patients' and lesions' characteristics, and outcomes of IMCS during PCI in patients with LVEF>35%. Results: (see table) 646 patients received elective IMCS during PCI, Impella 2.5 was used from 2008-2013, Impella CP was used afterwards. 166 patients had an LVEF>35%, the mean±standard deviation (STDV) LVEF was 52.65±9.15. When compared to patients with LVEF≤35%, patients with LVEF>35% were older, more female, had less CHF or prior MI, had more surgical consultations, and had similar STS mortality score. There were a trend toward more vessels treated, and significantly more lesions treated, more rotational atherectomy use, and left main coronary artery PCI in the group with LVEF>35%. There were no difference between the two groups in the incidence of major adverse cardiac and cerebrovascular events (MACCE), or hypotension during the procedure. However there was significantly increased bleeding requiring transfusion in the group with an LVEF>35%. The incidence of limb ischemia and PCI failure was very low inboth groups. Conclusion: 26% of patients who received IMCS during complex PCI have LVEF>35%; despite LVEF >35%, this group was at least as high risk for adverse PCIoutcomes as patients with LVEF <35%. IMCS during complex PCI in high risk patients with LVEF>35% is not uncommon and should be explored further.