New Generation mechanical circulatory support during high-risk PCI: a cross sectional analysis.

AIMS: To establish the value of new generation mechanical circulatory support (MCS) devices such as heartmate PHP (Abott), Impella CP (Abiomed) and PulseCath iVAC2L (Terumo).

METHODS AND RESULTS: we retrospectively analyzed all consecutive elective high-risk PCI procedures performed in the Erasmus Medical Center (2011-2018) thereby comparing MCS protected and unprotected patients. The primary end-point was a composite of procedure related adverse events including death (<24 hours), cardiac arrest, need for vasopressors, rescue MCS, endotracheal intubation and limb ischemia with need for surgery. Secondary end-points included 30day survival. A total of 198 elective high-risk PCI patients were included (69 (35%) MCS-protected, 129 (65%) MCS unprotected). When compared with unprotected patients, MCS protected patients had a significant worse LVEF (25±10vs33±8%,p<0.01) and higher syntax-I score (33±11vs24±8,p<0.01). The primary end-point occurred in 26 (20%) of the unprotected patients and in 6 (9%) of the MCS protected patients (OR 0.38,95% CI 0.15-0.97,p=0.04). Patients under 75 years of age, with a syntax I score above 32 and with a left ventricular ejection fraction below 30% showed most potential benefit from MCS. Survival during the first 24hours after the procedure and at 30days was significantly higher in MCS protected patients (100%vs95%,p=0.04 at 24hours and 98%vs87%,OR 10.32, 95%CI (1.34:79.31), p=0.006 at 30days).

CONCLUSIONS: In a consecutive real-world cohort of high-risk PCI patients, protection with new generation MCS resulted in better procedural outcomes despite worse EF and more complex coronary artery disease at baseline. Larger prospective studies need to confirm these findings.