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The Role of Mechanical Circulatory Support During Percutaneous Coronary Intervention in Patients Without Severely Depressed Left Ventricular Function
- Source :
- The American journal of cardiology. 121(6)
- Publication Year :
- 2017
-
Abstract
- Currently, there are no data on the use of mechanical circulatory support (MCS) in patients without severely depressed left ventricular ejection fraction (LVEF) during high-risk percutaneous coronary intervention (PCI). We analyzed data from the global catheter-based ventricular assist device (cVAD) registry on the clinical use of MCS in high-risk PCI in patients without severely depressed LVEF, defined as LVEF 35%. Patients without cardiogenic shock from the catheter-based ventricular assist device registry, who underwent elective or urgent PCI with an Impella 2.5 or Impella CP, were included. Patients who received MCS after the start of the PCI were excluded. A total of 891 patients were included, of whom 661 had LVEF ≤ 35% and 230 had LVEF 35%. Patients with LVEF 35% compared with patients with LVEF ≤ 35% were older (72.12 ± 11.70 years vs 68.68 ± 11.01 years; p 0.001), had more extensive coronary artery disease with more diseased vessels (1.90 ± 0.71 vs 1.73 ± 0.79; p = 0.005), more multivessel intervention (1.74 ± 0.69 vs 1.55 ± 0.73; p 0.001), and more use of rotational atherectomy (21.21% vs 14.90%; p = 0.046), respectively. Additionally, they had a high prevalence of high-risk clinical features such as renal failure (24.89%) and diabetes mellitus (45.37%). Despite these high-risk features, the major adverse cardiovascular and cerebral event rates were favorable overall, with no differences between the 2 groups (3.48% vs 4.54%; p = 0.574). Despite having LVEF 35%, this selected group of patients had severe co-morbidities and complex angiographic features; hence, PCI with hemodynamic support was deemed necessary. In addition, PCI with elective MCS was feasible and safe in this patient population.
- Subjects :
- Atherectomy, Coronary
Male
medicine.medical_specialty
medicine.medical_treatment
Comorbidity
Coronary Artery Disease
030204 cardiovascular system & hematology
Atherectomy
03 medical and health sciences
Ventricular Dysfunction, Left
0302 clinical medicine
Percutaneous Coronary Intervention
Risk Factors
Internal medicine
medicine
Humans
cardiovascular diseases
030212 general & internal medicine
Registries
Impella
Aged
Ejection fraction
business.industry
Cardiogenic shock
Percutaneous coronary intervention
Stroke Volume
medicine.disease
humanities
Survival Rate
Catheter
Treatment Outcome
Ventricular assist device
Conventional PCI
cardiovascular system
Cardiology
Female
Heart-Assist Devices
Cardiology and Cardiovascular Medicine
business
therapeutics
circulatory and respiratory physiology
Subjects
Details
- ISSN :
- 18791913
- Volume :
- 121
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- The American journal of cardiology
- Accession number :
- edsair.doi.dedup.....8e0d5a520b055a469b55db70e8a88184