Prevalence a Clinical Correlates of Vascular Access Adverse Events in Patients Receiving Extended Mechanical Circulatory Support for Percutaneous Coronary Interventions: Insights from the CVAD registry

Background:
Novel acute mechanical circulatory support devices (AMCS) have increased the success rate of complex coronary intervention with an associated safer profile. However, vascular access adverse events (VAAE) after percutaneous coronary interventions (PCI) that used large-bore catheters are associated with high morbidity and mortality. Here we sought to describe the incidence and clinical correlates of VAAE in patients receiving AMCS prior PCI.

Methods:
Retrospective analysis of patients enrolled in the CVAD Registry who underwent elective or urgent PCI. Cardiogenic shock and/or STEMI were excluded. The cohort was divided in two groups: patients in which the device was removed immediately after PCI (group A) and those in whom AMCS was extended following PCI. The decision to leave the device post PCI was at the discretion of the operator. The incidence and correlates of VAAE were analyzed using descriptive statistics.

Results:
A total of 507 patients were identified. In 464 (91.5%) patients the device was removed in the catheterization laboratory immediately after PCI. Conversely, 43 (8.5%) had extended AMCS (Group B). The prevalence and distribution of comorbidities were similar in both groups. Most patients had symptomatic congestive heart failure at admission (NYHA III or IV; 73.4% and 71.4%). Mean ejection fraction (EF) was similar in both groups (29.7% and 29.8%). The incidence of groin hematoma, and vascular complications requiring surgery were similar in both groups. However, the incidence of vascular complications not requiring surgery and access site bleeding requiring blood transfusion were significantly higher in group B when compared to group A (2.8% vs. 11.6% p=0.013 and 5.4% vs. 14% p=0.03). Moreover, all-cause mortality was significantly higher in group B (11.6% vs. 1.9%; p=0.004) when compared to group A.

Conclusions:
Periprocedural bleeding, transfusions and access site vascular complications not requiring surgery were higher in patients who underwent extended AMCS for elective or urgent PCI and were associated with higher mortality in an univariate analysis. Hence, pre-procedural planning, and comprehensive assessment of optimal vascular access and closure techniques are warranted in these patients.