Preprocedural vascular sheath insertion reduces hospital mortality in high risk PCI patients.

High-risk patients undergoing percutaneous coronary intervention (PCI) are prone to serious complications, such as ischemia-reperfusion injury, hemodynamic collapse, and cardiogenic shock. While mechanical circulatory support (MCS) may mitigate these risks, its prophylactic use is limited by increased healthcare costs and device-related complications. Preemptive insertion of femoral arteriovenous sheaths, a novel strategy designed to facilitate rapid MCS deployment in emergency situations, may address these concerns, but its clinical benefits remain unclear. In this multicenter retrospective study, we analyzed outcomes from 443 high-risk PCI patients to evaluate whether pre-inserting vascular sheaths before PCI improves patient outcomes. After propensity score matching, 110 matched pairs of patients were compared. Pre-insertion of vascular sheaths was associated with lower all-cause in-hospital mortality (4.5% vs. 18.2%; OR, 0.21; 95% CI, 0.08 ~ 0.59; P = 0.003) and a lower rate of poor neurological outcomes (9.1% vs. 19.1%; OR, 0.42; 95% CI, 0.19 ~ 0.96; P = 0.037). No significant differences were observed regarding the incidence of cardiogenic shock, MCS usage, or vascular complications. Our findings indicate that routine pre-insertion of vascular sheaths prior to high-risk PCI was associated with improved survival and better neurological outcomes, without a detectable increase in procedural complications, supporting its broader implementation in clinical practice.