This article is more than 5 years old. Information may no longer be current.
Initiation of percutaneous LVAD before PCI improves survival in high-risk patients
Initiation of percutaneous left ventricular assist device support before PCI on an unprotected left main coronary artery culprit lesion was associated with an early survival benefit in patients with acute MI complicated by cardiogenic shock, according to published findings.
For this study, Perwaiz M. Meraj, MD, FACC, FSCAI, of the department of cardiology at Northwell Health in Manhasset, New York, and colleagues evaluated data from patients in the ongoing, multicenter cVAD Registry who underwent PCI on an upper left main coronary artery lesion and were supported by a percutaneous LVAD (Impella 2.5, Abiomed). The primary endpoint was survival to discharge.
Of the 36 patients (mean age, 70 years; 78% men) included in the analysis, 72.7% were in cardiogenic shock at admission, 44.4% experienced at least one cardiac arrest and 30.6% were diagnosed with anoxic brain injury before initiation of percutaneous LVAD support.
More than half (55.6%) initiated percutaneous LVAD support before PCI and 44.4% initiated percutaneous LVAD support after PCI.
Overall, survival to discharge was 38.9%, according to the data, with patients who initiated percutaneous LVAD support before vs. after PCI faring better (55% vs. 18.8%; P = .041).
No patients with anoxic brain injury before percutaneous LVAD support survived to discharge, the researchers noted. Among the 25 patients without anoxic brain injury, survival to discharge was 56% overall, 84.6% among the 13 patients in the pre-PCI group and 25% among the 12 patients in the post-PCI group (P = .005).
Further, survival to discharge was 41.67% among all 24 patients with cardiogenic shock. Survival was better, however, in patients who initiated percutaneous LVAD support before vs. after PCI (75% vs. 8.3%; P = .003).
A Kaplan-Meier 30-day survival analysis also showed that survival was better for patients in the pre-PCI group vs. post-PCI group (48.1% vs. 12.5%; log-rank P = .004).
Overall, at baseline, the mean LV ejection fraction was 24.6%, Society of Thoracic Surgeons mortality score was 23.15 and duration of cardiogenic shock was longer than 24 hours in 32.3% of patients at the time of percutaneous LVAD initiation.
Baseline and procedural characteristics were comparable between groups, but patients in the pre-PCI group had more frequent transfer admission (55% vs. 18.8%; P = .041), and patients in the post-PCI group more frequently presented with STEMI (40% vs. 75%; P = .049), according to the data.
“Patients with cardiogenic shock complicating an acute MI due to an unprotected left main coronary artery culprit lesion are some of the sickest and most clinically challenging patients admitted in the cath lab,” Meraj said in a press release. “Our data suggest that early placement of Impella before PCI is vital to survival.” – by Melissa Foster
Disclosures: Cardiology Today’s Intervention could not obtain relevant financial disclosures.