Brian P O'Neill1, Cindy Grines2, Jeffrey W Moses3, E Magnus Ohman4, Alexandra Lansky5, Jeffery Popma6, Navin K Kapur7, Theodore Schreiber8, Salvatore Mannino9, William W O'Neill1, Amin M Medjamia10, Ehtisham Mahmud11. 1. Department of Cardiology, Henry Ford Hospital Center for Structural Heart, Detroit, Michigan, USA. 2. Department of Cardiology, Northside cardiovascular institute, Atlanta, Georgia, USA. 3. Department of Cardiology, Columbia University Medical Center, New York, New York, USA. 4. Department of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA. 5. Department of Cardiology, Yale University School of Medicine, New Haven, Connecticut, USA. 6. Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. 7. Cardiovascular Center for Research and Innovation, Tufts Medical Center, Boston, Massachusetts, USA. 8. Department of Cardiology, Ascension St. John Hospital, Warren, Michigan, USA. 9. Department of Cardiology, WellStar Kennestone Hospital, Marietta, Georgia, USA. 10. Department of Medical Affairs and Clinical Research, Abiomed Inc., Danvers, Massachusetts, USA. 11. Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California, USA.
Abstract
OBJECTIVES: To compare in-hospital outcomes of bailout support to prophylactic support with percutaneous ventricular assist devices (pVAD) for high-risk nonemergent percutaneous coronary intervention (HRPCI). BACKGROUND: Prophylactic support with pVAD for a HRPCI is used in patients felt to be at risk for hemodynamic collapse during PCI. An alternative strategy of bailout pVAD support in the event of hemodynamic collapse is also entertained. METHODS: We compared the outcomes of patients entered in the cVAD database who underwent Impella Protected PCI (ProPCI group) with patients from the cVAD and USpella databases receiving bailout Impella support for hemodynamic collapse during HRPCI (Bailout group). RESULTS: A total of 1,028 patients supported with Impella pVAD were entered into the cVAD database as of July 2019 and were included in this analysis. Of those 971 were in the ProPCI group and 57 in the Bailout group. Patients in the Bailout group were more often female (50.9%vs. 27.2%, p = .0002) with higher median baseline left ventricular ejection fraction (LVEF) (40%vs. 30%, p < .0001) and with lower prevalence of both heart failure (42.1%vs. 56.9%, p = .0385) and left main disease (40.0%vs. 56.1%, p = .0250) compared to the ProPCI group. Unadjusted and adjusted in-hospital mortality was significantly higher in the Bailout group (49.1%vs. 4.3%, and 57.8%vs. 4.4%, p < .0001 for both). CONCLUSIONS: In our study population, the bailout group was associated with significant increased mortality compared to ProPCI group. Female gender was more frequently observed in patients requiring bailout pVAD. Further investigation is warranted in order to generalize the findings of our study.
OBJECTIVES: To compare in-hospital outcomes of bailout support to prophylactic support with percutaneous ventricular assist devices (pVAD) for high-risk nonemergent percutaneous coronary intervention (HRPCI). BACKGROUND: Prophylactic support with pVAD for a HRPCI is used in patients felt to be at risk for hemodynamic collapse during PCI. An alternative strategy of bailout pVAD support in the event of hemodynamic collapse is also entertained. METHODS: We compared the outcomes of patients entered in the cVAD database who underwent Impella Protected PCI (ProPCI group) with patients from the cVAD and USpella databases receiving bailout Impella support for hemodynamic collapse during HRPCI (Bailout group). RESULTS: A total of 1,028 patients supported with Impella pVAD were entered into the cVAD database as of July 2019 and were included in this analysis. Of those 971 were in the ProPCI group and 57 in the Bailout group. Patients in the Bailout group were more often female (50.9%vs. 27.2%, p = .0002) with higher median baseline left ventricular ejection fraction (LVEF) (40%vs. 30%, p < .0001) and with lower prevalence of both heart failure (42.1%vs. 56.9%, p = .0385) and left main disease (40.0%vs. 56.1%, p = .0250) compared to the ProPCI group. Unadjusted and adjusted in-hospital mortality was significantly higher in the Bailout group (49.1%vs. 4.3%, and 57.8%vs. 4.4%, p < .0001 for both). CONCLUSIONS: In our study population, the bailout group was associated with significant increased mortality compared to ProPCI group. Female gender was more frequently observed in patients requiring bailout pVAD. Further investigation is warranted in order to generalize the findings of our study.