Bonnet Guillaume, Rommel Karl-Philipp, Falah Batla, Lansky Alexandra J, Zhang Yiran, Schonning Michael J, Redfors Björn, Burkhoff Daniel, Cohen David J, Basir M Babar, O'Neill William W, Granada Juan F
Cardiovacular Research Foundation New York NY USA.
Medico-Surgical Department Hopital Cardiologique Haut-Lévêque, Bordeaux University Hospital Bordeaux France.
J Am Heart Assoc. 2025 May 20;14(10):e036367. doi: 10.1161/JAHA.124.036367. Epub 2025 May 15.
Percutaneous left ventricular assist devices are used prophylactically to prevent hypotension during high-risk percutaneous coronary intervention. However, the impact of preprocedural hemodynamic profiles on procedural and clinical outcomes in these patients is unknown.
Patients from the central venous access device PROTECT III registry (NCT04136392) were categorized according to preprocedural mean blood pressure (MBP). Procedural and in-hospital outcomes, including hypotensive episodes, need for prolonged percutaneous left ventricular assist device support, and in-hospital death, were compared between groups. We also assessed the relationship between preprocedural MBP and 90-day major adverse cardiovascular and cerebrovascular events, which included all-cause death, myocardial infarction, stroke/transient ischemic attack, and repeat revascularization, as well as with 1-year mortality. A total of 1159 patients underwent percutaneous left ventricular assist device-supported high-risk percutaneous coronary intervention and were stratified into 4 hemodynamic profiles of preprocedural MBP level: MBP>100 mm Hg (n=242), >90 to ≤100 mm Hg (n=264), >80 to ≤90 mm Hg (n=306), and ≤80 mm Hg (n=347). Lower preprocedural MBP was associated with baseline anemia, history of heart failure, left main disease, and transfer from another hospital. In-hospital and procedural adverse outcomes did not differ between the BP categories. However, 90-day major adverse cardiovascular and cerebrovascular events rates and 1-year mortality increased with decreasing baseline BP levels. The association between BP category and 1-year mortality remained significant after adjustment for other factors (hazard ratio [HR], 0.79 [95% CI, 0.71-0.88], <0.001).
In a real-world cohort undergoing high-risk percutaneous coronary intervention with percutaneous left ventricular assist device support, there was no association between hemodynamic status and in-hospital outcomes. Lower preprocedural BP was associated with higher rates of 90-day major adverse cardiovascular and cerebrovascular events and 1-year mortality.
URL: https://www.clinicaltrials.gov; Unique identifier: NCT04136392.
经皮左心室辅助装置用于预防性地防止高危经皮冠状动脉介入治疗期间的低血压。然而，术前血流动力学参数对这些患者的手术及临床结局的影响尚不清楚。
来自中心静脉通路装置PROTECT III注册研究（NCT04136392）的患者根据术前平均血压（MBP）进行分类。比较各组之间的手术及院内结局，包括低血压发作、延长经皮左心室辅助装置支持的需求以及院内死亡。我们还评估了术前MBP与90天主要不良心血管和脑血管事件之间的关系，90天主要不良心血管和脑血管事件包括全因死亡、心肌梗死、中风/短暂性脑缺血发作和再次血运重建，以及与1年死亡率的关系。共有1159例患者接受了经皮左心室辅助装置支持的高危经皮冠状动脉介入治疗，并根据术前MBP水平分为4种血流动力学参数类型：MBP>100 mmHg（n = 242）、>90至≤100 mmHg（n = 264）、>80至≤90 mmHg（n = 306）和≤80 mmHg（n = 347）。术前较低的MBP与基线贫血、心力衰竭病史、左主干病变以及从另一家医院转诊有关。不同血压类别之间的院内和手术不良结局无差异。然而，90天主要不良心血管和脑血管事件发生率及1年死亡率随基线血压水平降低而增加。在对其他因素进行调整后，血压类别与1年死亡率之间的关联仍然显著（风险比[HR]，0.79[95%CI，0.71 - 0.88]，<0.001）。
在接受经皮左心室辅助装置支持的高危经皮冠状动脉介入治疗的真实世界队列中，血流动力学状态与院内结局之间无关联。术前较低的血压与90天主要不良心血管和脑血管事件发生率及1年死亡率较高有关。
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