Mid-long term results after elective Impella-supported, complex high-risk procedures of percutaneous coronary intervention

Abstract Background Mechanical circulatory support with percutaneous left ventricular assist device (pLVAD) in complex high-risk indicated procedures percutaneous of coronary intervention (CHIP-PCI) is an option for improving the haemodynamics of the patient during the intervention. There is little evidence regarding mid-long term prognosis after such procedures. Purpose We aim to describe mid-long term outcomes in patients in whom we used an Impella CP device for an elective CHIP-PCI, and identify prognostic factors for survival in our patients. Methods prospective analysis of consecutive patients who underwent elective CHIP-PCI with pLVAD support after heart team discussion in our center. We performed multivariate analysis with variables highlighted in the univariate analysis including baseline characteristics, coronary anatomy, analytic and echocardiographic findings, related to survival at follow-up. Results 39 elective supported CHIP-PCI were performed from 2017 to 2024 (characteristics at table 1). At admission, 59% presented with acute coronary syndrome (ACS), and 71.8% with decompensated heart failure (HF) (excluding STEMI and shocked patients). Overall in-hospital survival was 82.1% (n=32). After a median follow-up of 19 [IQR 44] months, survival was 69.2% (n=27) (causes of death in table 1). 33.3% of patients showed chronic HF at follow-up (15.4% with admission) with not statistically significant improvement in functional class compared to pre-revascularisation (mean NYHA 1,8 postPCI vs 2,6 prePCI, p=0.661) and significant improvement in left ventricular ejection fraction (LVEF) (40.5% vs 28.7%, p=0.003). 15.4% received an implantable cardioverter-defibrillator and none advanced HF therapies. 5.1% remained with chronic angina, 15.4% were admitted for ACS requiring new revascularization. At the multivariate analysis (table 2) the independent predictors of mid-long term survival were LVEF <35% and its overall value, the presence of at least moderate mitral regurgitation, hemoglobin, EUROSCORE II and STS mortality and morbidity scales, and the occurrence of vascular complications during PCI admission. Conclusion Mid-long term outcomes after elective CHIP-PCI supported with pLVAD showed improved LVEF and lower HF than at admission, with prognostic factors related to medium to long-term survival such as LVEF, mitral regurgitation, haemoglobin, risk scales and vascular complications.Table 1  Table 2