Real‐world supported unprotected left main percutaneous coronary intervention with impella device; data from the USpella registry

Schreiber, Theodore; Htun, Wah Wah; Blank, Nimrod; Telila, Tesfaye; Mercado, Nestor; Briasoulis, Αlexandros; Kaki, Amir; Kondur, Ashok; Ahmad, Mahmood; Grines, Cindy L.

doi:10.1002/ccd.26979

Cited by 37 publications

(28 citation statements)

References 16 publications

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“…However, all-cause death rates, for which the study was not powered, were similar between the two groups. Moreover, data regarding Impella supported PCI in patients undergoing unprotected left main (LM) revascularization have been extrapolated from the USpella registry [27] demonstrating its feasibility and safety. Although the analysis was mainly based on patients undergoing LM PCI, they achieved nearly complete revascularization with low procedural risk.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes of Extent of Revascularization in Complex High Risk and Indicated Patients Undergoing Impella-Protected Percutaneous Coronary Intervention: Report from the Roma-Verona Registry

Burzotta

Russo

Ribichini

et al. 2019

Journal of Interventional Cardiology

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Objective. To investigate the effect of extent of revascularization in complex high-risk indicated patients (CHIP) undergoing Impella-protected percutaneous coronary intervention (PCI). Background. Complete revascularization has been shown to be associated with improved outcomes. However, the impact of more complete revascularization during Impella-protected PCI in CHIP has not been reported. Methods. A total of 86 CHIP undergoing elective PCI with Impella 2.5 or Impella CP between April 2007 and December 2016 from 2 high volume Italian centers were included. Baseline, procedural, and clinical outcomes data were collected retrospectively. Completeness of coronary revascularization was assessed using the British Cardiovascular Intervention Society myocardial jeopardy score (BCIS-JS) derived revascularization index (RI). The primary end-point was all-cause mortality. A multivariate regression model was used to identify independent predictors of mortality. Results. All patients had multivessel disease and were considered unsuitable for surgery. At baseline, 44% had left main disease, 78% had LVEF ≤ 35%, and mean BCIS-JS score was 10±2. The mean BCIS-JS derived RI was 0.7±0.2 and procedural complications were uncommon. At 14-month follow-up, all-cause mortality was 10.5%. At follow-up, 67.4% of CHIP had LVEF ≥ 35% compared to 22.1% before Impella protected-PCI. Higher BCIS-JS RI was significantly associated with LVEF improvement (p=0.002). BCIS-JS RI of ≤ 0.8 (HR 0.11, 95% CI 0.01- 0.92, and p = 0.042) was an independent predictor of mortality. Conclusions. These results support the practice of percutaneous Impella use for protected PCI in CHIP. A more complete revascularization was associated with significant LVEF improvement and survival.

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Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes of Extent of Revascularization in Complex High Risk and Indicated Patients Undergoing Impella-Protected Percutaneous Coronary Intervention: Report from the Roma-Verona Registry

Burzotta

Russo

Ribichini

et al. 2019

Journal of Interventional Cardiology

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“…Indeed, Schreiber et al [15] reported recently a single-center experience which demonstrated favorable in-hospital and 30-day survival (98.43% and 97.74%, respectively) among patients with depressed LV function (28.74±15.55%) and multiple comorbidities (Society of Thoracic Surgeon (STS) morbidity score of 23.6±12.04) who underwent prophylactic Impella support for a ULMCA PCI. The predicted surgical mortality estimated by the STS score in these patients was lower than the STS mortality score of our patients (3.59±3.63 vs. 6.06±6.57), suggesting a less sick patient population who might have been eligible for surgical revascularization.…”

Section: Discussionmentioning

confidence: 99%

Nonemergent Percutaneous Coronary Intervention on an Unprotected Left Main Coronary Artery Supported with Impella® Heart Pump in Patients Ineligible for Surgical Revascularization

Meraj

Dixon

Moses

et al. 2019

Journal of Interventional Cardiology

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Objectives. We sought to assess if ineligibility to coronary artery bypass grafting (CABG) constitutes a risk factor in patients who underwent a nonemergent unprotected left main coronary artery (ULMCA) percutaneous coronary intervention (PCI) with prophylactic Impella® heart pump support. Background. ULMCA PCI in patients not deemed eligible for CABG is associated with significantly worse outcomes compared to ULMCA PCI in eligible patients. Methods. Patients from the cVAD Registry and the PROTECT II trial who underwent a nonemergent ULMCA PCI were identified. We compared in-hospital mortality and major adverse cardiac and cerebrovascular event (MACCE) rates as well as 30-day survival and MACCE rates between CABG ineligible and CABG eligible patients. Results. A total of 331 patients were included (293 Impella 2.5®, 38 Impella CP®); 227 were ineligible for CABG and 104 were eligible. Baseline characteristics were remarkable for a trend toward higher rate of chronic obstructive pulmonary disease in the ineligible patients. In-hospital mortality (3.52% vs. 5.77%; p=0.383) and MACCE (6.61% vs. 7.69%; p=0.816) rates as well as 30-day survival (92.0% vs. 93.4%; Log-Rank p-value =0.781) and MACCE (88.1% vs. 90.1%; Log-Rank p-value=0.648) rates were not different between the two groups. Conclusions. The results of our study suggest that prophylactic Impella support appears to mitigate the risks inherent to surgical ineligibility in patients undergoing a nonemergent ULMCA PCI. Our results require further investigation.

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“…The results of a recently reported study suggest that in non-CS patients undergoing LMCA PCI, prophylactic insertion of the Impella ventricular assist device may be associated with improved procedural success rates and reduced complication rates [ 5 ]. Accordingly, Impella insertion prior to LMCA stenting may also be considered in selected hemodynamically stable patients with iatrogenic LMCA dissection.…”

Section: Discussionmentioning

confidence: 99%

“…The Impella device is a percutaneously inserted miniaturized ventricular assist device that is being increasingly used in the treatment of patients with acute myocardial infarction complicated by cardiogenic shock (AMICS) [ 1 – 4 ]. It has also been found to have a potentially valuable role in increasing the safety and efficacy of high-risk coronary interventional procedures (PCI), such as stenting of unprotected left main stem coronary artery (ULMCA) [ 5 ]. Using a retrograde femoral (or, occasionally, axillary) artery access, it is generally placed using standard percutaneous techniques in the left ventricular chamber (LV) across the aortic valve.…”

Section: Introductionmentioning

confidence: 99%

Successful Treatment of Occlusive Left Main Coronary Artery Dissection by Impella-Supported Stenting

Glazier

Kaki

Schreiber

2018

Case Reports in Cardiology

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We report successful treatment of a patient, who, during diagnostic angiography, developed an ostial left main coronary artery dissection with stump occlusion of the vessel. First, mechanical circulatory support with an Impella CP device was established. Then, patency of the left coronary system was achieved by placement of stents in the left anterior descending, left circumflex, and left main coronary arteries. On completion of the procedure, left ventricular systolic function, as assessed by echocardiography, was normal. At 24-month clinical follow-up, the patient remains angina-free and well. This is the first reported case of the use of an Impella device to support treatment of iatrogenic left main coronary artery dissection.

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Real‐world supported unprotected left main percutaneous coronary intervention with impella device; data from the USpella registry

Abstract: This large singe center retrospective evaluation of USpella registry substantiates and strongly supports the feasibility, safety, and hemodynamic usefulness of Impella device for ULMI with acceptable in-hospital and 30-day MACE rates. © 2017 Wiley Periodicals, Inc.

Cited by 37 publications

References 16 publications

Long-Term Outcomes of Extent of Revascularization in Complex High Risk and Indicated Patients Undergoing Impella-Protected Percutaneous Coronary Intervention: Report from the Roma-Verona Registry

Long-Term Outcomes of Extent of Revascularization in Complex High Risk and Indicated Patients Undergoing Impella-Protected Percutaneous Coronary Intervention: Report from the Roma-Verona Registry

Nonemergent Percutaneous Coronary Intervention on an Unprotected Left Main Coronary Artery Supported with Impella® Heart Pump in Patients Ineligible for Surgical Revascularization

Successful Treatment of Occlusive Left Main Coronary Artery Dissection by Impella-Supported Stenting

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