TCT-971 Analysis of Impella and IABP Supported Elective HR-PCI Outcomes and EF Recovery in a Large U.S. Based Electronic Medical Record Database

Document Type

Conference Proceeding

Publication Date

10-28-2025

Publication Title

J Am Coll Cardiol

Abstract

Background: PROTECT-II and RESTORE-EF demonstrated LVEF improvements in MCS-supported HRPCI. However, the REVIVED BCIS-2 did not show EF improvement in HF patients undergoing PCI. Methods: We analyzed electronic medical record data (2017-2025) from TRUVETA, a national database aggregating de-identified patient level data across 31 geographically diverse healthcare systems in the U.S. (TRUVETA Inc., Bellevue, WA, USA). We compared patients who received Impella (PLVAD)- with IABP-supported elective high-risk PCI. We excluded patients admitted emergently, STEMI, cardiogenic shock, right heart failure or CABG. A 1:1 propensity score matching (PSM) was performed using co-variates related to the outcomes of interest, including age, sex, history of CHF, reduced LVEF, diabetes, NSTEMI, CKD, cancer, and admissions for ACS, HF, angina, CAD and baseline LVEF. Outcomes and adverse events measured 30 day included all-cause mortality (M-30d), acute kidney injury (AKI), bleeding requiring transfusions (BRT). We evaluated change in ejection fraction (ΔLVEF) defined as difference between pre-PCI LVEF and values reported within 12-months post-PCI. Results: We identified 2794 PLVAD, and 1884 IABP. Prior to PSM adjustment, PLVAD patients were older compared to IABP patients (73±11 vs 68±11 yrs, SMD=0.38), more likely to have a history of CHF (49% vs 24%, SMD=0.54), NSTEMI (34% vs 16%, SMD=0.42) and HFrEF (43% vs 19%, SMD=0.55), anemia (24% vs 15%, SMD=0.23) had lower baseline LVEF (34% vs 40%, SMD=0.22) and more often treated with 2 vessel PCI (50% vs 22% SMD=0.58). The unadjusted rates of M-30d were 12% vs 16% (p<.001) and LVEF gain were 7% vs 3% (p<.001), in PLVAD and IABP, respectively. The PSM identified 1531 patients in each group. After PSM, M-30d were 13% vs 17% (p = 0.003), AKI were 16% vs 20% (p = 0.001), and ΔLVEF were 7% vs 3% (p=. 04), in PLVAD and IABP, respectively. No differences were observed in 30-day or BRT. Conclusion: In this observational analysis of EMR data, patients receiving PLVAD tend to be sicker, have lower baseline EF, and undergo more extensive PCI. After PSM, PLVAD-supported PCI was associated with lower all-cause mortality(30-d), AKI, and greater degree of EF improvement than IABP patients. Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)

Volume

86

Issue

17

First Page

B415

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