TCT-216 Defining High-Risk Percutaneous Coronary Intervention: Characteristics of Patients Undergoing Contemporary Percutaneous Coronary Intervention With Axial-Flow Mechanical Support

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Background: There is no universally accepted definition of high-risk percutaneous coronary intervention (HRPCI), nor is there consensus regarding when to use axial-flow mechanical circulatory support (MCS) during HRPCI. Expert opinions have suggested considering MCS in the presence of patient comorbidities, complex coronary anatomy, and adverse hemodynamics. Methods: Patients from 46 US centers who underwent Impella-supported HRPCI between 2017 and 2020 and were prospectively enrolled in the cVAD PROTECT III study were analyzed. Patient and procedural characteristics commonly cited as factors prompting use of MCS for HRPCI were classified as (A) complex coronary anatomical features, (B) medical comorbidities, and/or (C) adverse hemodynamic characteristics (Figure 1). Patients were analyzed to assess how many possessed 1, 2, or all 3 factors and, within each category, the number of individual features. Results: Of 1,237 patients, n = 1,020 (82.5%) patients had factors in groups A, B, and C, n = 20 (1.6%) in groups A and B, n = 69 (5.6%) in groups A and C, and n = 123 (9.9%) in groups B and C (Figure 1). No patients had medical comorbidities (B) only, only n = 5 (0.4%) patients had complex hemodynamic features (C) only, and no patients had complex coronary anatomy (A) only. Most patients had 2 or more features within each high-risk domain. [Formula presented] Conclusion: In this contemporary study, most patients undergoing Impella-assisted HRPCI possessed multiple medical comorbidities and multiple adverse hemodynamic and multiple complex coronary anatomical features, suggesting that the confluence of all 3 factors influence decision-making for use of MCS. Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)

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