Complex High-Risk Coronary Intervention with Percutaneous Ventricular Support: An Analysis of Complete vs Target Lesion Revascularization
Presenter
Behnam N. Tehrani, M.D., Inova Heart and Vascular Institute, Oakton, VA
Behnam N. Tehrani, M.D.1, Abdulla A Damluji, MD, PhD, MPH2, Carolyn M. Rosner, MSN, RN, FNP-BC3, Siqi Wei4, James Park, BS2, Hooman Bakhshi, MD2, Nicholas Balaji, M.D.5, Nicholas Cossa6, Christopher R Defilippi, M.D.7, Kelly Epps, M.D.8, Edward W. Howard, M.B.B.S.9, Nadim A. Geloo, M.D., FSCAI10, Joseph M. Kiernan III, M.D., FSCAI11, Mitchell Psotka, MD, PhD, MPH2, Narian Rajan, MD2, Matthew W. Sherwood, M.D., FSCAI12, Shashank Sinha, MD, MSc7, Rahsaan Smith, MD2, Eugene K. Soh, M.D.13, Hamid Taheri, M.D.14, Alexander G. Truesdell, M.D., FSCAI15, Shahram Yazdani, M.D.16 and Wayne B. Batchelor, M.D., FSCAI12, (1)Inova Heart and Vascular Institute, Oakton, VA, (2)INOVA Heart and Vascular Institute, Falls Church, VA, (3)Inova Fairfax Hospital, Falls Church, VA, (4)George Mason University, Fairfax, VA, (5)The Heart Center of Northeast Georgia Medical Center, Falls Church, VA, (6)Virginia Heart / INOVA Heart and Vascular Institute, Mclean, VA, (7)Inova Health System, Falls Church, VA, (8)Inova Fairfax Hospital, Washington, DC, (9)Virginia Heart, Annandale, VA, (10)Abbott, Fairfax, VA, (11)Virginia Heart, Vienna, VA, (12)Inova Fairfax Hospital, McLean, VA, (13)Carient Heart and Vascular, Manassas, VA, (14)Inova Fairfax Hospital, Mclean, VA, (15)Virginia Heart / Inova Schar Heart and Vascular Institute, Mclean, VA, (16)Virginia Cardiovascular Associates, Mc Lean, VA
Keywords: Complex and High-risk Coronary Intervention (CHIP), Coronary and Hemodynamic support
Background:
Percutaneous ventricular assist devices (pVAD) are frequently used for hemodynamic support during complex high risk and indicated percutaneous coronary interventions (CHIP-PCI). Notwithstanding benefits of complete revascularization (CR), outcomes following complete- vs target-lesion revascularization (TR) during pVAD assisted CHIP-PCI remain unknown.
Methods:
From 06/2018 to 08/2020, 75 consecutive patients underwent pVAD assisted CHIP-PCIs at a single academic institution. Major adverse cardiac events (death, MI, stroke, 30 day rehospitalization, repeat revascularization) were evaluated at 30 days according to revascularization strategy (CR vs. TR).
Results:
The median age of study population was 77 (IQR 71,82) years, 69% were males, 49% had diabetes, and 61% had left main disease. Clinical Frailty Score was ≥ 6 in 2/3 ofpatients. Of the 75 patients who received pVAD (Impella: 97%; TandemHeart: 3%), 51% received CR and 49% underwent TR. Patients with TR had lower LVEF (30% vs 35%; p=0.023), higher SYNTAX 1 (38 vs 31; p=0.005), SYNTAX II (59 vs 50; p<0.001), and baseline PA diastolic pressures (31 vs 23 mm Hg; p=0.033). CR was associated with lower 30-day MACE compared to TR (21.1% vs 43.2%, p=0.049), driven primarily by a reduction in stroke (0% vs 18.9%, p=0.005). No differences in 30-day survival, acute kidney injury, bleeding and vascular complications were noted (Figure).
Conclusions:
In this study population, CR during pVAD assisted CHIP-PCI was associated with reduced 30-day MACE compared to TR. The extent to which differences in baseline characteristics may influence MACE during follow-up merits further investigation 