Improvement in left ventricular function and clinical outcomes following higher-risk percutaneous coronary intervention with hemodynamic support
Russo J, Doshi D, Karmpaliotis D, Parikh MA, Ali ZA, Popma JJ, Ohman EM, Douglas PS, O'Neill W, Leon MB, Moses JW, and Kirtane AJ. Improvement in left ventricular function and clinical outcomes following higher-risk percutaneous coronary intervention with hemodynamic support. Catheter Cardiovasc Interv 2019; 93(Suppl 2):S45.
Catheter Cardiovasc Interv
Background: There is a lack of data on clinical outcomes following higher-risk percutaneous coronary intervention (HRPCI) with hemodynamic support in patients with ischemic cardiomyopathy. Methods: Change in left ventricular ejection fraction (ΔLVEF) following HRPCI was assessed among patients randomized to Impella 2.5 versus intra-aortic balloon pump (IABP) in the PROTECT II trial. We included surviving patients with paired echocardiographic data at baseline and at 90 days. Clinical outcomes were assessed in relation to assigned device and ΔLVEF following HRPCI. The primary outcome was the composite of myocardial infarction, repeat revascularization, or heart failure hospitalization. Results: A total of 304 patients met inclusion criteria (mean age 67 years; mean LVEF 24%); baseline characteristics were similar among patients treated with Impella versus IABP. Mean ΔLVEF following HRPCI was 7.5±9.5% (8.1±9.6% with Impella vs. 6.8±9.4% with IABP, p = 0.25); 190 patients (53%) had ΔLVEF≥5%. There was no association between ΔLVEF≥5% and the odds of the primary outcome (OR 0.92; 95%CI 0.52-1.62; p = 0.77). Treatment assignment to Impella 2.5 compared to IABP was associated with lower rates of the primary outcome (14.3% vs. 28.0%, p = 0.005; Figure). Conclusions: Among surviving patients with paired echocardiographic data, ejection fraction improved following HRPCI. The use of Impella 2.5 was associated with improved 90-day outcomes compared to IABP, particularly among patients with ΔLVEF≥5%. (Table Presented).