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Percutaneous LVAD reduces acute kidney injury in high-risk patients undergoing PCI
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Partial hemodynamic support with a microaxial percutaneous left ventricular assist device was associated with reduce acute kidney injury during high-risk PCI, according to published findings.
The researchers conducted a retrospective study of 230 patients with LV ejection fraction 35% who underwent high-risk PCI; 115 patients who had the procedure with the percutaneous LVAD (Impella 2.5, Abiomed) were matched with 115 controls who had it without the device.
“A substantial number of high-risk PCI patients have both severely reduced [LV] function and underlying kidney disease, and during their procedure, these patients are exposed to high levels of contrast dye, which further compromises kidney function,” Michael P. Flaherty, MD, associate professor of medicine and physiology at University of Louisville School of Medicine, Kentucky, said in a press release. “We found that, despite severely reduced ejection fractions and baseline chronic kidney disease, Impella-supported patients were six times less likely to develop acute kidney injury, underscoring the importance of Impella as part of a renal protective strategy during high-risk PCI.”
The primary outcome was in-hospital acute kidney injury as determined by acute kidney injury network criteria. The researchers performed logistic regression analysis to determine predictors of acute kidney injury.
The primary outcome was observed in 5.2% of patients supported by the percutaneous LVAD vs. 27.8% of controls (P < .001).
Postprocedural hemodialysis was needed on 0.9% of patients in the percutaneous LVAD group vs. 6.1% in the control group (P < .05), according to the researchers.
Support with the percutaneous LVAD was independently associated with reduced chance for acute kidney injury (adjusted OR = 0.13; 95% CI, 0.09-0.31), according to the researchers.
The device was associated with reduced kidney injury even in patients with pre-existing chronic kidney disease (adjusted OR = 0.63; 95% CI, 0.25-0.83) or lower ejection fraction (adjusted OR = 0.16; 95% CI, 0.12-0.28), Flaherty and colleagues wrote.
“We believe that kidney injury resulting from episodic decrease in flow during high-risk PCI can be reduced with Impella support and that stagnation of contrast in renal tubules may be minimized,” Flaherty said in the release. “The use of Impella, then, is especially important as more patients undergo complete revascularization rather than staged procedures, ostensibly improving periprocedural kidney blood flow and reducing the toxic effects of contrast dye despite low ejection fraction, baseline renal insufficiency and longer procedure times.” – by Erik Swain
Disclosure: Flaherty reports receiving an institutional research grant and speaker honoraria from Abiomed. The other researchers report no relevant financial disclosures.
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