Januszek Rafał, Pawlik Artur, Rzeszutko Łukasz, Bartuś Krzysztof, Bartuś Stanisław
Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland.
Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland.
Kardiol Pol. 2022;80(12):1224-1231. doi: 10.33963/KP.a2022.0203. Epub 2022 Sep 1.
Patients and mechanical circulatory support assortment, as well as periprocedural and post-procedural clinical outcomes in complex high-risk percutaneous coronary interventions (PCIs) underpinned by percutaneous left ventricular assist devices (pLVAD) are the subject of debate.
The study aimed to identify differences between patients qualified for complex high-risk PCIs with an intra-aortic balloon pump (IABP) or Impella pump support and to compare peri- and post-procedural clinical outcomes.
The presented analysis is a single-center study, which comprised consecutive patients undergoing complex high-risk PCIs performed with the pLVAD, either IABP or Impella. Patients included in the current analysis were recruited between January 2018 and December 2021. There were 28 (56%) patients in the Impella group and 22 (44%) in the IABP group. The primary endpoints included overall mortality and major adverse cardiovascular events (MACE) such as all-cause mortality, myocardial infarction, revascularization, and cerebrovascular events.
Patients from the IABP group were significantly older, had higher left ventricular ejection fraction (LVEF), and less frequent history of PCI, while the in-hospital risk of death assessed by EuroSCORE II remained similar in the Impella and IABP groups (median interquartile range [IQR] 2.8 [2-3.8] vs. 2.5 [1.8-5.2]; P = 0.73). Patients undergoing complex high-risk PCIs with pLVAD support presented similar results during the follow-up, assessed by log-rank estimates in terms of MACE (P = 0.41) and mortality rate (P = 0.65).
The use of pLVAD devices in patients undergoing complex high-risk PCIs, with reduced left ventricular ejection fraction, is a promising treatment option for patients disqualified from surgery by cardiac surgeons.
在经皮左心室辅助装置（pLVAD）支持下的复杂高危经皮冠状动脉介入治疗（PCI）中，患者和机械循环支持的选择以及围手术期和术后的临床结果是有争议的话题。
本研究旨在确定符合使用主动脉内球囊泵（IABP）或Impella泵支持进行复杂高危PCI的患者之间的差异，并比较围手术期和术后的临床结果。
本分析是一项单中心研究，纳入了连续接受使用pLVAD、IABP或Impella进行复杂高危PCI的患者。纳入本分析的患者于2018年1月至2021年12月期间招募。Impella组有28例（56%）患者，IABP组有22例（44%）患者。主要终点包括全因死亡率和主要不良心血管事件（MACE），如全因死亡率、心肌梗死、血运重建和脑血管事件。
IABP组患者年龄显著更大，左心室射血分数（LVEF）更高，PCI病史更少见，而根据欧洲心脏手术风险评估系统（EuroSCORE）II评估的住院死亡风险在Impella组和IABP组中相似（中位数四分位间距[IQR]2.8[2 - 3.8]对2.5[1.8 - 5.2]；P = 0.73）。在随访期间，接受pLVAD支持的复杂高危PCI患者在MACE（P = 0.41）和死亡率（P = 0.65）方面的结果相似，通过对数秩估计进行评估。
对于左心室射血分数降低且被心脏外科医生判定不适合手术的患者，在复杂高危PCI中使用pLVAD装置是一种有前景的治疗选择。
