TCT-214 Right Ventricular Function in Patients Undergoing Impella-Assisted High-Risk Percutaneous Coronary Intervention: Insights From the cVAD PROTECT III Study

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Background: Right ventricular dysfunction (RVD) is an important prognostic factor in several cardiac conditions. However, the impact of RVD on the clinical outcome of patients undergoing Impella-assisted high-risk percutaneous coronary intervention is unknown. Methods: Patients from the prospective, multicenter PROTECT III study were stratified according to the presence of RVD, defined as fractional area change <35%, tricuspid annular plane systolic excursion <17 mm, or S wave of the lateral tricuspid annulus <9.5 cm/s. Endpoints were in-hospital outcomes, 90-day major adverse cardiac and cerebrovascular events (death, myocardial infarction, stroke, repeat revascularization), and 1-year mortality. Results: Of 239 patients who underwent RV function assessment, 124 had RVD. Lower left ventricular ejection fraction, higher blood urea nitrogen levels, and more severe RV dilatation were independently associated with RVD. The completeness of revascularization and in-hospital mortality did not differ significantly between patients with and without RVD. However, 90-day major adverse cardiac and cerebrovascular event rates were higher in patients with RVD, and RVD was a robust predictor of 1-year mortality with multivariable Cox regression analyses (Figure 1). [Formula presented] Conclusion: In the PROTECT III cohort of patients undergoing Impella-assisted high-risk percutaneous coronary intervention, RVD was associated with more advanced biventricular failure. Left ventricular support with Impella facilitated effective revascularization, even among those with concomitant RVD. Nevertheless, RVD was associated with unfavorable long-term prognoses. Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)

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