Kardiologia polska · 2025
A two-center registry of high-risk percutaneous coronary intervention with Impella CP support: The KRAKpella Registry - age and use of vasoactive agents as independent in-hospital mortality risk factors.
СтатьяНаблюдательное исследованиеМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Bartuś Stanisław, Pawlik Artur, Dziewierz Artur, Rzeszutko Łukasz, Niewiara Łukasz, Roczniak Jan, Kwiatkowska Ewa, Kasprzycki Karol, Chyrchel Bernadeta, Chyrchel Michał, Heba Grzegorz, Zasada Wojciech, Cugowska Monika, Gruszka Krystian, Sabatowski Karol, Suska Marcin, Klima Łukasz, Terlecki Michał, Szolc Piotr, Rakowski Tomasz, Wojdyła Roman, Sorysz Danuta, Wizimirski Marcin, Rajzer Marek, Surdacki Andrzej, Bryniarski Leszek, Kleczyński Paweł, Legutko Jacek
Аннотация
BACKGROUND: High-risk percutaneous coronary intervention (PCI) in patients with complex coronary artery disease (CAD), multiple comorbidities, and reduced left ventricular ejection fraction (LVEF) carries significant risk of hemodynamic compromise. Percutaneous left ventricular assist devices (Impella CP, Abiomed, Danvers, MA, US) may provide beneficial left ventricular support during these procedures. This study aimed to identify factors influencing outcomes of patients deemed unsuitable for bypass surgery who underwent high-risk PCI with Impella CP support.
MATERIAL AND METHODS: This two-center observational study enrolled non-shock patients undergoing elective and semi-elective high-risk PCI with Impella CP support between June 2017 and January 2024. The analysis included patient demographics, comorbidities, procedural characteristics, and clinical outcomes.
RESULTS: The study population comprised 171 patients (86.5% male) with substantial comorbidities: diabetes mellitus (50.3%), chronic kidney disease (43.9%), nicotine addiction (26.3%), and peripheral artery disease (22.8%). Median LVEF was 22.0% (IQR 18.0-26.0). Most patients had extensive CAD, with multivessel involvement in 90.7% and left main CAD in 66.1%. In-hospital mortality was 5.8%, and 1-year all-cause mortality reached 14.6%. Advanced age and periprocedural vasoactive agent requirement emerged as independent predictors of in-hospital mortality.
CONCLUSIONS: This registry demonstrates that Impella CP-supported high-risk PCI is feasible and relatively safe in patients with complex CAD and severely reduced LVEF. Advanced age and requirement for periprocedural vasopressors emerged as significant predictors of in-hospital mortality. Further studies are needed to identify patients most likely to benefit from this intervention.
MATERIAL AND METHODS: This two-center observational study enrolled non-shock patients undergoing elective and semi-elective high-risk PCI with Impella CP support between June 2017 and January 2024. The analysis included patient demographics, comorbidities, procedural characteristics, and clinical outcomes.
RESULTS: The study population comprised 171 patients (86.5% male) with substantial comorbidities: diabetes mellitus (50.3%), chronic kidney disease (43.9%), nicotine addiction (26.3%), and peripheral artery disease (22.8%). Median LVEF was 22.0% (IQR 18.0-26.0). Most patients had extensive CAD, with multivessel involvement in 90.7% and left main CAD in 66.1%. In-hospital mortality was 5.8%, and 1-year all-cause mortality reached 14.6%. Advanced age and periprocedural vasoactive agent requirement emerged as independent predictors of in-hospital mortality.
CONCLUSIONS: This registry demonstrates that Impella CP-supported high-risk PCI is feasible and relatively safe in patients with complex CAD and severely reduced LVEF. Advanced age and requirement for periprocedural vasopressors emerged as significant predictors of in-hospital mortality. Further studies are needed to identify patients most likely to benefit from this intervention.