Journal
CLINICAL RESEARCH IN CARDIOLOGY
Volume 107, Issue 8, Pages 653-657Publisher
SPRINGER HEIDELBERG
DOI: 10.1007/s00392-018-1230-6
Keywords
Heart-assist device; Hemodynamics; High-risk PCI; Impella; Mechanical support
Categories
Funding
- DZHK (Deutsches Zentrum fur Herz-Kreislauf-Forschung-German Centre for Cardiovascular Research)
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Percutaneous coronary intervention (PCI) is an alternative strategy to coronary artery bypass grafting (CABG) in patients with high perioperative risk. The microaxial Impella(A (R)) pump (Abiomed, Danvers, MA, USA), used as prophylactic and temporary support, is currently the most common device for protected high-risk PCI to ensure hemodynamic stability during complex coronary intervention. The study is an observational, retrospective multi-center registry. Patients from nine tertiary hospitals in Germany, who have undergone protected high-risk PCI, are included in the present study. A total of 154 patients (mean age 72.6-10.8 years, 75.3% male) were enrolled. The majority were at a high operative risk illustrated by a logistic EuroSCORE of 14.7-17.4. The initial SYNTAX score was 32.0-13.3, indicating very complex CAD and could be reduced to 14.1-14.3 (p < 0.0001) after PCI. The main reasons for protected PCI were complex coronary anatomy (70.8%), personal impression (56.5%), reduced ventricular ejection fraction (49.4%), comorbidities (47.4%), and surgical turndown (30.5%). Four patients (2.6%) experienced an intrahospital death. Data from the study show that protected PCI is a safe and effective approach to revascularize high-risk patients with complex coronary anatomy and comorbidities.
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