Clinical characteristics and outcomes of patients requiring prolonged mechanical circulatory support after high-risk percutaneous coronary intervention

被引:2
作者
Min, Sugi [2 ]
Basir, Mir Babar [3 ]
Lemor, Alejandro [4 ]
Zhou, Zhipeng [5 ]
Abu-Much, Arsalan [5 ]
Redfors, Bjorn [5 ,6 ,7 ]
Thompson, Julia B. [5 ]
Truesdell, Alexander G. [8 ,9 ]
Bharadwaj, Aditya S. [10 ]
Li, Yanru
Kaki, Amir [11 ]
Brott, Brigitta C. [12 ]
Wohns, David H. [13 ]
Meraj, Perwaiz M. [14 ]
Daggubati, Ramesh [15 ]
Grines, Cindy L. [16 ,17 ]
O'Neill, William W. [18 ]
Moses, Jeffrey W. [1 ,2 ,19 ]
机构
[1] Columbia Univ, Med Ctr, 161 Ft Washington Ave, New York, NY 10032 USA
[2] Columbia Univ, Irving Med Ctr, Dept Med, New York, NY USA
[3] Henry Ford Hosp, Div Cardiol, Detroit, MI USA
[4] Univ Mississippi, Med Ctr, Dept Cardiol, Jackson, MS USA
[5] Cardiovasc Res Fdn, Clin Trials Ctr, New York, NY USA
[6] Sahlgrens Univ Hosp, Dept Cardiol, Gothenburg, Sweden
[7] Gothenburg Univ, Sahlgrenska Acad, Dept Mol & Clin Med, Gothenburg, Sweden
[8] Virginia Heart, Falls Church, VA USA
[9] INOVA Heart & Vasc Inst, Falls Church, VA USA
[10] Loma Linda Univ, Med Ctr, Div Cardiol, Loma Linda, CA USA
[11] Ascens St John Hosp & Ctr, Intervent Cardiol Dept, Detroit, MI USA
[12] Univ Alabama Birmingham, Dept Med, Div Cardiovasc Dis, Birmingham, AL USA
[13] Spectrum Hlth, Frederik Meijer Heart & Vasc Inst, Grand Rapids, MI USA
[14] Zucker Sch Med, Dept Cardiol, Northwell Hlth, Manhasset, NY USA
[15] West Virginia Univ, Div Cardiol, Morgantown, WV USA
[16] Med Coll Georgia, Augusta, GA USA
[17] Northside Hosp Cardiovasc Inst, Atlanta, GA USA
[18] Ctr Struct Heart Dis, Dept Cardiol, Henry Ford Hlth Care Syst, Detroit, MI USA
[19] St Francis Heart Ctr, Roslyn, NY USA
关键词
clinical outcomes; high-risk percutaneous coronary intervention; major adverse cardiovascular and cerebrovascular events; mechanical circulatory support; HEMODYNAMIC SUPPORT; CARDIOGENIC-SHOCK; BALLOON PUMP; MORTALITY; TRIAL; PCI;
D O I
10.4244/EIJ-D-23-00512
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND: There are limited data on the clinical characteristics and outcomes of patients who require prolonged mechanical circulatory support (MCS) after Impella-supported high -risk percutaneous coronary intervention (HR-PCI). AIMS: The aim of this study is to describe the contemporary clinical characteristics, outcomes, and predictors associated with prolonged MCS support after assisted HR-PCI. METHODS: Patients enrolled in the prospective, multicentre, clinical endpoint -adjudicated PROTECT III study who had undergone HR-PCI using Impella were evaluated. Patient and procedural characteristics and outcomes for those who received prolonged MCS beyond the duration of their index procedure were compared to those in whom MCS was successfully weaned and explanted at the conclusion of the index PCI. RESULTS: Among 1,155 patients who underwent HR-PCI with Impella between 2017 and 2020 and had sufficient data to confirm the duration of Impella support, 16.5% received prolonged MCS (mean duration 25.2 +/- 31.1 hours compared with 1.8 +/- 5.8 hours for those who only received intraprocedural MCS). Patients receiving prolonged support presented with more urgent indications (e.g., acute coronary syndromes [ACS], lower ejection fraction [EF], elevated baseline heart rate and lower systolic blood pressure). Use of the Impella CP, intraprocedural complications, periprocedural complications and in -hospital mortality were all more common amongst the prolonged MCS group. Prolonged MCS was associated with increased rates of major adverse cardiovascular and cerebrovascular events, cardiovascular death, and all -cause mortality at 90 -day follow-up. CONCLUSIONS: Patients receiving prolonged MCS after Impella-supported HR-PCI presented with more ACS, reduced EF and less favourable haemodynamics. Additionally, they were more likely to experience intraprocedural and periprocedural complications as well as increased in -hospital and post -discharge mortality.
引用
收藏
页码:E135 / E145
页数:13
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