Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (M.Z., G.M.G., P.Z., D.M.W., S.V.R., T.Y.W.).
Division of Cardiology, Department of Medicine, NYU Langone Medical Center' New York (N.R.S.).
Circ Cardiovasc Interv. 2022 May;15(5):e011534. doi: 10.1161/CIRCINTERVENTIONS.121.011534. Epub 2022 May 17.
Mechanical circulatory support (MCS) devices can be used in high-risk percutaneous coronary intervention (PCI). Our objective was to describe trends and outcomes of prophylactic MCS use in elective PCI for patients with stable coronary artery disease in the American College of Cardiology National Cardiovascular Data Registry's CathPCI registry.
Among 2 108 715 consecutive patients with stable coronary artery disease undergoing elective PCI in the CathPCI registry between 2009 and 2018, we examined patterns of prophylactic use of MCS. Propensity score models with inverse probability of treatment weighting compared effectiveness (in-hospital death, cardiogenic shock, or new heart failure) and safety (stroke, tamponade, major bleeding, or vascular complication requiring treatment) between patients treated with intra-aortic balloon pump versus other MCS (Impella or extracorporeal membrane oxygenation).
Overall, 6905 (0.3%) patients underwent elective PCI with prophylactic MCS. MCS use trended up from 0.2% of elective PCIs in 2009 to 0.6% in 2018 (<0.0001), driven by other MCS (<0.0001), whereas intra-aortic balloon pump use remained low and constant (=0.12). In-hospital major adverse cardiac events and cardiovascular complications occurred in 7.1% and 18.8% of elective PCI patients with prophylactic MCS use and 0.5% and 2.3% of patients without prophylactic MCS use. Intra-aortic balloon pump use was associated with a higher risk of major adverse cardiac events (9.6% versus 6.0%, adjusted odds ratio, 1.59 [95% CI, 1.32-1.91]) but lower risk of complications (18.2% versus 19.1%, adjusted odds ratio, 0.88 [95% CI, 0.77-0.99]) than use of other MCS.
The use of prophylactic MCS has increased over time for elective PCI in patients with stable coronary artery disease. Intra-aortic balloon pump was associated with higher major adverse cardiac events but lower risk of procedural complications compared with other MCS.
机械循环支持（MCS）设备可用于高危经皮冠状动脉介入治疗（PCI）。我们的目的是描述在 ACC 国家心血管数据注册中心的 CathPCI 注册中心中，在稳定型冠状动脉疾病患者中进行择期 PCI 时预防性使用 MCS 的趋势和结果。
在 2009 年至 2018 年间，在 CathPCI 注册中心接受择期 PCI 的 2108715 例稳定型冠状动脉疾病连续患者中，我们研究了预防性使用 MCS 的模式。使用逆概率处理加权的倾向评分模型比较了使用主动脉内球囊泵与其他 MCS（Impella 或体外膜肺氧合）的患者之间的有效性（住院期间死亡、心源性休克或新发心力衰竭）和安全性（中风、心脏压塞、大出血或需要治疗的血管并发症）。
总体而言，6905 例（0.3%）患者接受了择期 PCI 伴预防性 MCS。MCS 的使用从 2009 年的择期 PCI 的 0.2%上升到 2018 年的 0.6%（<0.0001），主要是由于其他 MCS（<0.0001）的使用，而主动脉内球囊泵的使用则保持较低且稳定（=0.12）。在接受预防性 MCS 的择期 PCI 患者中，住院期间主要不良心脏事件和心血管并发症的发生率分别为 7.1%和 18.8%，而未接受预防性 MCS 的患者分别为 0.5%和 2.3%。与使用其他 MCS 相比，使用主动脉内球囊泵与更高的主要不良心脏事件风险相关（9.6%比 6.0%，调整后比值比，1.59[95%CI，1.32-1.91]），但与较低的并发症风险相关（18.2%比 19.1%，调整后比值比，0.88[95%CI，0.77-0.99]）。
在稳定型冠状动脉疾病患者中，择期 PCI 时预防性使用 MCS 的比例随时间推移而增加。与其他 MCS 相比，主动脉内球囊泵与更高的主要不良心脏事件相关，但与较低的操作并发症风险相关。
