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Journal of Interventional Cardiology
Volume 2019, Article ID 9691753, 9 pages
https://doi.org/10.1155/2019/9691753
Research Article

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

1Northwell Health, Department of Cardiology, Manhasset, NY 11030, USA
2Beaumont Health, Department of Cardiovascular Medicine, Royal Oak, MI 48073, USA
3Columbia University Medical Center, New York, NY 10032, USA
4Technische Universität Dresden, Department of Internal Medicine and Cardiology, Dresden, Germany
5Hannover Medical Center, Department of Cardiology and Angiology, Hannover, Germany
6Mannheim Medical School, Department of Cardiology and Angiology, Mannheim, Germany
7King’s College Hospital, London SE5 9RS, UK
8Detroit Medical Center, Department of Cardiology, Detroit, MI 48201, USA
9Henry Ford Medical Center, Department of Interventional Cardiology and Structural Heart, Detroit, MI, USA

Correspondence should be addressed to Perwaiz M. Meraj; moc.liamg@ziawrep

Received 18 August 2018; Accepted 7 March 2019; Published 4 June 2019

Academic Editor: Salvatore De Rosa

Copyright © 2019 Perwaiz M. Meraj et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.