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Outcomes of Impella-supported high-risk nonemergent percutaneous coronary intervention in a large single-center registry

Azzalini L, MD, Johal GS, Baber U, Bander J, Moreno PR, Barman N, Kini AS,  Bazi L, Kapur V, Sharma SK. Catheter Cardiovasc Interv. 2020;1–8.

Key Points:

  • This report focuses on the early and one-year results of high-risk, non-urgent percutaneous coronary intervention (PCI) supported by Impella.
  • The authors state the goal is to provide additional understanding for an Impella support concept for high-risk PCI.
  • Study population includes all patients between 2009 and 2018 at The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York undergoing high-risk, non-emergent PCI supported by Impella 2.5 or CP.
  • A propensity matched group of 250 patients having PCI with no hemodynamic was compared to the 250 patients in the Impella support group.
  • Both groups had similar clinical and angiographic characteristics
  • Procedural characteristics for the Impella supported group tended to be more complex with significantly more frequent Left Main PCI (26% vs. 11%, p < 0.001) with a trend toward more frequent rotational atherectomy in the PCI group (44% vs. 37%, P = 0.10) and a higher number of treated vessels (1.8 vs. 1.3, p < 0.001).
  • Despite higher acute adverse events for the Impella group (peri-procedure MI, and major bleeding), the one-year results were equivalent for the two groups (MACE for Impella – 31.2% vs. Control – 27.4%, p = .78).
  • These results provide important reassurance that Impella hemodynamic support provides a substrate for effective late results despite more complex disease in non-emergent, high-risk PCI.