100.58 Intravascular Imaging or Angiographic Guidance in Patients Undergoing Impella-Supported High-Risk Percutaneous Coronary Intervention
Recommended Citation
Abu-Much A, Bonnet G, Zhao D, Wollmuth JR, Thompson JB, Moses JW, Redfors B, Bharadwaj AS, Lansky AJ, Falah B, Cohen DJ, Truesdell AG, O'Neill WW. 100.58 Intravascular Imaging or Angiographic Guidance in Patients Undergoing Impella-Supported High-Risk Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2024; 17(4):S16.
Document Type
Conference Proceeding
Publication Date
2-1-2024
Publication Title
JACC Cardiovasc Interv
Abstract
Background: Recent randomized trials examining intravascular imaging in complex percutaneous coronary interventions (PCI) have been conflicting. Notably, these trials were focused on anatomic complexity rather than patient (pt.) risk and thus did not include patients who required mechanical circulatory support during PCI. Therefore, we sought to explore outcomes associated with using intravascular imaging during high-risk PCI (HR-PCI) procedures supported by Impella devices. Methods: We analyzed data from the PROTECT III trial (NCT04136392); a multicenter, observational study of Impella-supported HR-PCI that enrolled patients at 46 U.S. centers from March 2017 to March 2020. Pts were categorized according to the use of intravascular imaging. The primary outcome was the rate of adjudicated major adverse cardiac and cerebrovascular events (MACCE: all-cause death, myocardial infarction, stroke/transient ischemic attack, and revascularization) at 90 d., as well as 1 yr. mortality. Multivariable Cox proportional hazard analysis was conducted with adjustment based on a propensity score (PS). Results: Of 1237 pts enrolled in the cVAD PROTECT III study, 958 had data on intravascular imaging, 477 (50%) of whom underwent intravascular imaging-guided PCI. Baseline characteristics and study outcomes are summarized in Table. After PS adjustment, use of intravascular imaging was not associated with significant reductions in the risk of 90-day MACCE (Adj. HR=0.68 [95% CI 0.44, 1.04], p=0.08) or 1-year mortality (Adj. HR=0.91 [95% CI 0.64, 1.28], p=0.58). Conclusion: Although underpowered to detect statistically significant differences, our study of pts undergoing Impella-supported HRPCI exhibits that the use of intravascular imaging was associated with a trend toward lower 90 d. MACCE, but no notable change in 1 yr. all-cause mortality. [Formula presented]
Volume
17
Issue
4
First Page
S16
