LV unloading before PCI with pVAD reduced max CK-MB (309.1 vs. 541.2 U/L) and improved EF change at 3 months (10.8% vs. 0.38%) in broad anterior MI patients.
Does left ventricular unloading prior to PCI with a percutaneous micro-axial ventricular assist device reduce infarct size and improve cardiac function in patients with broad anterior acute myocardial infarction without cardiogenic shock?
Left ventricular unloading with a pVAD prior to PCI in patients with broad anterior acute MI without cardiogenic shock significantly reduces infarct size and improves left ventricular ejection fraction at 3 months compared to standard care.
Absolute Event Rate: 0% vs 0%
Abstract Background Percutaneous micro-axial ventricular assist device (pVAD) is a promising alternative to improve prognosis in patients with cardiogenic shock requiring mechanical cardiac support (MCS). However, the effect of left ventricular (LV) unloading prior to percutaneous coronary intervention (PCI) with pVAD on infarct size and cardiac prognosis in patients with broad anterior acute myocardial infarction (MI) remains to be determined. Methods In this single-center study, consecutive 34 patients who had broad anterior acute MI without cardiogenic shock and received PCI from January 2019 to January 2025 were retrospectively evaluated. Clinical characteristics, maximum creatine kinase MB isoenzyme (CK-MB) levels due to MI and cardiac function were evaluated comparing between patients treated with pVAD and standard care. Results Of all ST-segment elevated MI patients, 9 (26.5%) received pVAD prior to PCI and 25 (73.5%) standard care. Mean age was 68 years old. Onset-to-door time did not differ significantly between the two groups (p=0.20), whereas door-to-unloading time in the pVAD group was significantly longer than door-to-balloon time in the standard care group (door-to-unloading/balloon time: 49.1 vs. 31.7 mins, p 0.001). Despite of its long door-to-unloading/balloon time, maximum CK-MB was significantly lower and changes in ejection fraction (EF) acquired by ultrasonography between index and 3 months were significantly greater in the pVAD group than the standard care group (CK-MB: 309.1 ± 188.4 vs. 541.2 ± 262.5 U/L, p=0.021, change in EF: 10.8 ± 7.9 vs. 0.38 ± 9.0 %, p=0.017). Conclusion LV unloading prior to PCI with pVAD was associated with decreased infarct size of broad anterior acute MI and improved LV function during 3 months after index compared to standard care, indicating potential benefit of the strategy, LV unloading prior to PCI with pVAD, to improve prognosis even in patients with broad anterior acute MI at risk for cardiogenic shock
Shishikura et al. (Sat,) reported a other. LV unloading before PCI with pVAD reduced max CK-MB (309.1 vs. 541.2 U/L) and improved EF change at 3 months (10.8% vs. 0.38%) in broad anterior MI patients.