From the Cardiovascular Medicine, University of Louisville School of Medicine, KY (M.P.F., S.P., T.K., S.D., J.H.L., W.R.); Internal Medicine, Sparks Regional Medical Center, Fort Smith, AR (S.V.P.); Cardiology, University of Kansas Medical Center, Kansas City (B.D.); Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO (A.C.); and Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (C.R.B.).
Circ Res. 2017 Feb 17;120(4):692-700. doi: 10.1161/CIRCRESAHA.116.309738. Epub 2017 Jan 10.
Acute kidney injury (AKI) is common during high-risk percutaneous coronary intervention (PCI), particularly in those with severely reduced left ventricular ejection fraction. The impact of partial hemodynamic support with a microaxial percutaneous left ventricular assist device (pLVAD) on renal function after high-risk PCI remains unknown.
We tested the hypothesis that partial hemodynamic support with the Impella 2.5 microaxial pLVAD during high-risk PCI protected against AKI.
In this retrospective, single-center study, we analyzed data from 230 patients (115 consecutive pLVAD-supported and 115 unsupported matched-controls) undergoing high-risk PCI with ejection fraction ≤35%. The primary outcome was incidence of in-hospital AKI according to AKI network criteria. Logistic regression analysis determined the predictors of AKI. Overall, 5.2% (6) of pLVAD-supported patients versus 27.8% (32) of unsupported control patients developed AKI (<0.001). Similarly, 0.9% (1) versus 6.1% (7) required postprocedural hemodialysis (<0.05). Microaxial pLVAD support during high-risk PCI was independently associated with a significant reduction in AKI (adjusted odds ratio, 0.13; 95% confidence intervals, 0.09-0.31; <0.001). Despite preexisting CKD or a lower ejection fraction, pLVAD support protection against AKI persisted (adjusted odds ratio, 0.63; 95% confidence intervals, 0.25-0.83; =0.04 and adjusted odds ratio, 0.16; 95% confidence intervals, 0.12-0.28; <0.001, respectively).
Impella 2.5 (pLVAD) support protected against AKI during high-risk PCI. This renal protective effect persisted despite the presence of underlying CKD and decreasing ejection fraction.
急性肾损伤（AKI）在高危经皮冠状动脉介入治疗（PCI）中很常见，特别是在左心室射血分数严重降低的患者中。使用微型轴流式经皮左心室辅助装置（pLVAD）进行部分血液动力学支持对高危 PCI 后肾功能的影响尚不清楚。
我们检验了这样一个假设，即在高危 PCI 中使用 Impella 2.5 微型轴流式 pLVAD 进行部分血液动力学支持可预防 AKI。
在这项回顾性、单中心研究中，我们分析了 230 例（115 例连续接受 pLVAD 支持，115 例未接受支持的匹配对照）接受射血分数≤35%的高危 PCI 患者的数据。主要结局是根据 AKI 网络标准评估的住院期间 AKI 的发生率。逻辑回归分析确定了 AKI 的预测因素。总体而言，pLVAD 支持组的患者中有 5.2%（6 例）发生 AKI，而未接受支持组的患者中有 27.8%（32 例）发生 AKI（<0.001）。同样，0.9%（1 例）需要接受术后血液透析，而未接受支持组的患者中有 6.1%（7 例）需要接受血液透析（<0.05）。高危 PCI 期间使用微型轴流式 pLVAD 支持与 AKI 的显著降低独立相关（调整后的优势比，0.13；95%置信区间，0.09-0.31；<0.001）。尽管存在预先存在的 CKD 或较低的射血分数，pLVAD 支持对 AKI 的保护作用仍然存在（调整后的优势比，0.63；95%置信区间，0.25-0.83；=0.04 和调整后的优势比，0.16；95%置信区间，0.12-0.28；<0.001）。
Impella 2.5（pLVAD）支持可预防高危 PCI 中的 AKI。这种肾脏保护作用在存在潜在 CKD 和射血分数降低的情况下仍然存在。
