Outcomes of bailout percutaneous ventricular assist device versus prophylactic strategy in patients undergoing nonemergent percutaneous coronary intervention

• Published in: Catheterization and cardiovascular interventions Vol. 98; no. 4; pp. E501 - E512
• Main Authors: O'Neill, Brian P, Grines, Cindy, Moses, Jeffrey W., Ohman, E. Magnus, Lansky, Alexandra, Popma, Jeffery, Kapur, Navin K., Schreiber, Theodore, Mannino, Salvatore, O'Neill, William W., Medjamia, Amin M., Mahmud, Ehtisham
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.10.2021; Wiley Subscription Services, Inc
• Subjects: Angioplasty; Bailouts; complex PCI; Congestive heart failure; coronary artery disease; ECMO/IABP/Tandem/Impella; mechanical circulatory support; Mortality; Patients; percutaneous coronary intervention; Population studies; Ventricle
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.29758

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.