Jakob Philipp, Lansky Alexandra J, Basir Mir B, Schonning Michael J, Falah Batla, Zhou Zhipeng, Batchelor Wayne B, Abu-Much Arsalan, Grines Cindy L, O'Neill William W, Stähli Barbara E
Department of Cardiology, University Heart Center, University Hospital Zurich and the Center for Translational and Experimental Cardiology (CTEC) University of Zurich Zurich Switzerland.
Department of Cardiology Yale University School of Medicine New Haven CT USA.
J Am Heart Assoc. 2025 May 6;14(9):e038509. doi: 10.1161/JAHA.124.038509. Epub 2025 Apr 16.
In patients undergoing high-risk percutaneous coronary intervention, Impella has become an important adjunctive tool to support revascularization. The impact of age on the outcomes of patients undergoing high-risk percutaneous coronary intervention is limited. The aim of this study is to describe the characteristics and outcomes of patients ≥75 years of age undergoing Impella-supported high-risk percutaneous coronary intervention.
Baseline characteristics and outcomes of patients ≥75 years of age versus those of patients <75 years of age in patients enrolled in the cVAD PROTECT III (Catheter-Based Ventricular Assist Device Prospective, Multi-Center, Randomized Controlled Trial of the IMPELLA RECOVER LP 2.5 System Versus Intra Aortic Balloon Pump in Patients Undergoing Non Emergent High Risk Percutaneous Coronary Intervention) study (NCT04136392). Major adverse cardiovascular and cerebral events (composite of all-cause death, nonfatal myocardial infarction, stroke/transient ischemic attack, and repeat revascularization) were assessed at 30 and 90 days and all-cause death at 1 year. Out of 1237 patients, 493 (39.9%) patients were ≥75 years of age. Patients ≥75 years of age had less diabetes and prior myocardial infarction, more hypertension and dyslipidemia, worse renal function, more severe valvular heart disease, but higher left ventricular ejection fraction (<0.05 for all comparisons). Baseline Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery scores were similar between groups. Older patients underwent more left main percutaneous coronary intervention (58% versus 39%; <0.0001), atherectomy (32% versus 22%; <0.0001), and femoral access (87% versus 79%, =0.0003) as compared with younger patients. In-hospital vascular complications did not differ, but rates of respiratory failure, pericardial tamponade, and cardiogenic shock were higher in older patients. Rates of all-cause death and major adverse cardiovascular and cerebral events did not differ between groups at 30 and 90 days. Rates of all-cause death at 1 year were higher in patients ≥75 years (adjusted hazard ratio, 1.99 [95% CI, 1.24-3.18], =0.004).
Impella-supported high-risk percutaneous coronary intervention in older patients is feasible with an acceptable safety profile. However, age ≥75 years remained a statistically significant predictor for all-cause death at 1 year.
URL: https://clinicaltrials.gov; Unique Identifier: NCT04136392.
在接受高风险经皮冠状动脉介入治疗的患者中，Impella已成为支持血运重建的重要辅助工具。年龄对接受高风险经皮冠状动脉介入治疗患者预后的影响有限。本研究的目的是描述年龄≥75岁接受Impella支持的高风险经皮冠状动脉介入治疗患者的特征和预后。
在cVAD PROTECT III（基于导管的心室辅助装置前瞻性、多中心、随机对照试验：IMPELLA RECOVER LP 2.5系统与主动脉内球囊反搏在接受非急诊高风险经皮冠状动脉介入治疗患者中的比较）研究（NCT04136392）中，比较年龄≥75岁患者与年龄<75岁患者的基线特征和预后。在30天和90天时评估主要不良心血管和脑血管事件（全因死亡、非致命性心肌梗死、中风/短暂性脑缺血发作和再次血运重建的复合事件），并在1年时评估全因死亡。在1237例患者中，493例（39.9%）患者年龄≥75岁。年龄≥75岁的患者糖尿病和既往心肌梗死较少，高血压和血脂异常较多，肾功能较差，瓣膜性心脏病更严重，但左心室射血分数较高（所有比较P<0.05）。两组之间经皮冠状动脉介入治疗与心脏手术的基线协同评分相似。与年轻患者相比，老年患者接受左主干经皮冠状动脉介入治疗的比例更高（58%对39%；P<0.0001）、旋切术的比例更高（32%对22%；P<0.0001）以及股动脉入路的比例更高（87%对79%，P=0.0003）。住院期间血管并发症无差异，但老年患者呼吸衰竭、心包填塞和心源性休克的发生率更高。30天和90天时两组之间全因死亡和主要不良心血管和脑血管事件的发生率无差异。年龄≥75岁患者1年时的全因死亡率更高（调整后的风险比，1.99[95%CI，1.24 - 3.18]，P=0.004）。
Impella支持的老年患者高风险经皮冠状动脉介入治疗是可行的，安全性可接受。然而，年龄≥75岁仍然是1年时全因死亡的统计学显著预测因素。
