Microaxial blood pump confers better outcomes in high-risk PCI vs. IABP
In a cohort of patients who underwent high-risk PCI, mechanical circulatory support with a microaxial blood pump was linked to lower odds of death, MI and cardiogenic shock compared with use of an intra-aortic balloon pump.
Alexandra J. Lansky, MD, professor of medicine at Yale School of Medicine, cardiologist at Yale-New Haven Hospital and director of the Yale Heart and Vascular Clinical Research Program and the Yale Cardiovascular Research Center, and colleagues analyzed 2,156 patients included in the Premier Healthcare Database who underwent nonemergent PCI supported by a microaxial blood pump (Impella family of devices, Abiomed) or intra-aortic balloon pump (IABP) between April 2016 and June 2019.
“The reality in the cath lab is that our patients are increasingly complex with ischemic heart failure, reduced left ventricular ejection fraction, calcified lesions, diffuse disease and surgical turndown,” Lansky told Healio. “Whether Impella-supported PCI can improve our revascularization results by stabilizing patients’ hemodynamics during the procedure compared to IABP is a crucial question in today’s practice. Our study is the largest contemporary cohort to address this question.”
After propensity adjustment to control for baseline, procedure and post-PCI medical treatment differences, patients treated with an Impella device had higher odds of in-hospital survival (adjusted OR = 1.55; 95% CI, 95% CI, 1.02-2.36; P = .042) and lower odds of in-hospital MI (aOR = 0.29; 95% CI, 0.18-0.46; P < .0001) and cardiogenic shock (aOR = 0.54; 95% CI, 0.39-0.74; P = .0001).
There were no differences between the groups in the following in-hospital outcomes: stroke, bleeding requiring transfusion and acute kidney injury.
“With greater mechanical support, greater cardiac output and afterload reduction with Impella compared to IABP, we anticipate better optimization of revascularization and better patient outcomes,” Lansky told Healio.
In addition, the Impella group had a shorter adjusted length of stay compared with the IABP group (3.4 days vs. 4.8 days; P < .0001).
“Our results provide added evidence of the benefits of using Impella during high-risk PCI to stabilize hemodynamics, prevent hemodynamic collapse, enable optimal revascularization and improve clinical outcomes,” Lansky told Healio. “We look forward to the large-scale ongoing prospective, randomized PROTECT IV trial, which is designed to definitively confirm the benefit of Impella compared to standard PCI (with or without IABP) in this high-risk patient population.”
For more information:
Alexandra J. Lansky, MD, can be reached at alexandra.lansky@yale.edu.
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