Document Type

Conference Proceeding

Publication Date


Publication Title

J Am Coll Cardiol


Background: There are limited data on predicative parameters to guide weaning after high-risk percutaneous coronary intervention (HRPCI) requiring mechanical circulatory support (MCS).

Methods: Patients enrolled into the prospective, multicenter, adjudicated, PROTECT III study who underwent HRPCI with Impella MCS were evaluated. Patients who required prolonged MCS, defined as requiring ongoing MCS beyond the index PCI, were compared to those in whom MCS was successfully weaned and explanted after index PCI.

Results: 1,196 patients were treated at 46 sites between 2017 and 2020. 207 patients (17%) required prolonged support with a mean duration of support of 27.3 ± 34.2 compared to 1.8 ± 5.8 hours for those not requiring prolonged support. Age, gender, and baseline comorbidities were similar between groups. Patients requiring prolonged support had a lower left ventricular ejection fraction (27.3 vs 31.8, P = 0.02), lower blood pressure (BP) pre-PCI (120 vs 126, P < 0.01) and during PCI (121 vs 131, P < 0.01), and higher heart rate pre-PCI (80 vs 76, P < 0.01) and during PCI (82 vs 76, P < 0.01). Patients requiring prolonged support were more likely to undergo urgent PCI (62 vs 49%, P < 0.01), present with acute coronary syndrome (ACS) (44.9 vs 29.7%, P < 0.01) and were more likely to experience intra-procedural complication (9.1 vs 3.9%, P < 0.01). Patients requiring prolonged support were also more likely to die during the hospitalization (10.6% vs 2.8%, P < 0.01) and experience major adverse cardiac and cerebral events (MACCE) at 90 days (23.4 vs 13.9%, P < 0.01). The need for prolonged hemodynamic support was significantly associated with cardiovascular death using logistic regression (OR 2.49, P = 0.04).

Conclusion: Patients requiring prolonged support after HRPCI present with more urgent indications for PCI (ie, acute coronary syndrome) and are more likely to have intraprocedural complication. These patients have lower baseline ejection fractions, lower blood pressure, and are more likely to experience in-hospital death and 90-day MACCE.

Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)





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