Author + information
- Francesco Burzotta1,
- Giulio Russo1,
- Flavio Ribichini2,
- Anna Piccoli3,
- Domenico D'Amario1,
- Lazzaro Paraggio1,
- Leonardo Previ1,
- Gabriele Pesarini4,
- Italo Porto5,
- Antonio Maria Leone1,
- Giampaolo Niccoli1,
- Cristina Aurigemma1,
- Diana Verdirosi1,
- Carlo Trani6 and
- Filippo Crea5
- 1Institute of Cardiology, Catholic University of the Sacred Heart, Policlinico A. Gemelli, Rome, Rome, Italy
- 2University of Verona, Verona, Verona, Italy
- 3Division of Cardiology, University of Verona, Verona, Verona, Italy
- 4Univeristy of Verona, Verona, Verona, Italy
- 5Institute of Cardiology, Catholic University of the Sacred Heart, Policlinico A. Gemelli, Roma, Rome, Italy
- 6Institute of Cardiology, Catholic University of the Sacred Heart, Policlinico A. Gemelli, Italy, Rome, Rome, Italy
Many high risk (HR) percutaneous coronary interventions (PCI) are being performed with mechanical cardiac assistance. The data available demonstrated safety and feasibility of HR-PCI under Impella-pump protection (pIMP). However, poor data exist about outcome predictors in HR procedures.
We retrospectively identified consecutive patients who underwent elective PCI with pIMP in two Italian high-volume tertiary centers. Access site complications were graded according to the BARC classification. Extent of myocardial revascularization was investigated using the Revascularization Index (RI) by comparing British Cardiovascular Intervention Society (BCIS) score before and after PCI. Left ventricle ejection fraction (LVEF) before PCI and at the longest available follow-up was assessed. Primary study end-point was all-cause mortality.
A total of 85 patients with both stable or unstable coronary artery disease underwent pIMP PCI. Mean EuroSCORE was 9±3, mean Syntax score was 31±10 and mean BCIS score was 10±2. All patients were treated by PCI with full percutaneous (hemostasis attempted using a double perclose preclosure technique or prostar) IMP support using 2.5 (n=74; 87%) or CP pumps (n=11; 13%). Mean RI was 0.7±0.2. BARC complications occurred in 10 patients (12%). After a mean follow-up time of 14 months, 76 patients were alive (all cause mortality: 10.5%). Overall, EF significantly improved from 31±9% to 39±9% (P<0.001) and 61.0% (n=36) patients exhibited a >25% increase of LVEF. At multivariate analysis, RI significantly predicted survival (P=0.045).
The results of the present real-world two-centre registry support the safety and feasibility of pIMP PCI to manage HR patients. In this cohort, EF increased during the follow-up. The extent of revascularization achieved in the cath lab may affect survival.
CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)