TCT-241 Clinical Characteristics and Outcomes of Impella-Supported High-Risk PCI in Patients Turned Down for Coronary Artery Bypass Graft Surgery: Insights From the cVAD PROTECT III Study

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Background: Impella-assisted percutaneous coronary intervention (PCI) is increasingly offered for patients deemed prohibitive risk for coronary artery bypass grafting (CABG), but limited data exist on the characteristics, reasons for turndown, and outcomes of these patients. Methods: Patients from the prospective, multicenter observational PROTECT III study who underwent Impella-assisted high-risk PCI were categorized into groups: CABG turndown by a cardiothoracic surgeon (CTS) or patients declining CABG despite surgical eligibility. Baseline characteristics and major adverse cardiovascular and cerebrovascular events (MACCE) at 30 and 90 days were assessed. Results: Of 1,235 patients, 791 evaluated for CABG were analyzed; 86.0% (n = 680) turned down by a CTS, and 14.0% (n = 111) declined surgery. Baseline characteristics are shown in Table 1. Comorbidities (40.4%; n = 275) and anatomical and hemodynamic reasons (24.0%, n = 163 for each) were the main factors for CTS turndown. Patients declining CABG showed no difference in 30-day MACCE compared with patients who declined surgery but had lower MACCE at 90 days (P = 0.02) (Figure 1). [Formula presented] [Formula presented] Conclusion: Results from PROTECT III reveal that patients who declined CABG had lower MACCE at 90 days. Further research is needed to enhance our understanding and risk stratification of patients with complex coronary disease undergoing evaluation for Impella-assisted high-risk PCI. Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)

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