Improvement in Left Ventricular Function and Clinical Outcomes Following Higher-risk Percutaneous Coronary Intervention with Hemodynamic Support

Russo, Juan

Improvement in Left Ventricular Function and Clinical Outcomes Following Higher-risk Percutaneous Coronary Intervention with Hemodynamic Support

Tuesday, May 21, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Juan Russo, M.D. , Columbia University Medical Center, New York, NY

Darshan Doshi, M.D. , Massachusetts General Hospital, Boston, MA

Dimitrios Karmpaliotis, M.D. , Center for Interventional Vascular Therapy, Columbia University Medical Center, New York, NY

Manish A. Parikh, M.D., FSCAI , Columbia University/NY Presbyterian Hospital, New York, NY

Ziad A. Ali, M.D., Ph.D. , Center for Interventional Vascular Therapy, Columbia University Medical Center, New York, NY

Jeffrey J. Popma, M.D. , Beth Israel Deaconess Medical Center, Boston, MA

E. M. Ohman, M.D., FSCAI , Duke University Medical Center, Durham, NC

Pamela S Douglas, M.D. , Duke University, Durham, NC

William W. O'Neill , M.D., MSCAI , Henry Ford Hospital, Detroit, MI

Martin B. Leon, M.D., FSCAI , Columbia University Medical Center, New York, NY

Jeffrey W. Moses, M.D., FSCAI , Columbia University Medical Center, New York, NY

Ajay J. Kirtane, M.D., FSCAI , Columbia University Medical Center, Demarest, NJ

Background:
There is a lack of data on clinical outcomes following higher-risk percutaneous coronary intervention (HRPCI) with hemodynamic support in patients with ischemic cardiomyopathy.

Methods:
Change in left ventricular ejection fraction (ΔLVEF) following HRPCI was assessed among patients randomized to Impella 2.5 versus intra-aortic balloon pump (IABP) in the PROTECT II trial. We included surviving patients with paired echocardiographic data at baseline and at 90 days. Clinical outcomes were assessed in relation to assigned device and ΔLVEF following HRPCI. The primary outcome was the composite of myocardial infarction, repeat revascularization, or heart failure hospitalization.

Results:
A total of 304 patients met inclusion criteria (mean age 67 years; mean LVEF 24%); baseline characteristics were similar among patients treated with Impella versus IABP. Mean ΔLVEF following HRPCI was 7.5±9.5% (8.1±9.6% with Impella vs. 6.8±9.4% with IABP, p=0.25); 190 patients (53%) had ΔLVEF≥5%. There was no association between ΔLVEF≥5% and the odds of the primary outcome (OR 0.92; 95%CI 0.52-1.62; p=0.77). Treatment assignment to Impella 2.5 compared to IABP was associated with lower rates of the primary outcome (14.3% vs. 28.0%, p=0.005; Figure).

Conclusions:
Among surviving patients with paired echocardiographic data, ejection fraction improved following HRPCI. The use of Impella 2.5 was associated with improved 90-day outcomes compared to IABP, particularly among patients with ΔLVEF≥5%.