What is the clinical evidence from this study?

Study design: Observational. Population: Chronic Coronary Artery Disease With Heart Failure undergoing non-emergent PCI. Intervention: Impella Support (Mechanical Circulatory Support) vs. No Mechanical Circulatory Support. Primary outcome: MACE at 30 days (HR 0.99, 95% CI 0.90-1.09).

What question did this study set out to answer?

To assess outcomes of Impella support during non-emergent PCI in elderly patients with chronic coronary artery disease and heart failure.

April 26, 2026Open Access

A-34 | Outcomes of Impella Support in Elderly Patients Undergoing Non-Emergent PCI for Chronic Coronary Artery Disease With Heart Failure

Key Result

Impella support during non-emergent PCI without baseline shock was associated with similar 30-day MACE compared to no MCS (46.4% vs 45.7%; HR 0.99, 95% CI 0.90-1.09) but higher all-cause mortality.

Key Points

To assess outcomes of Impella support during non-emergent PCI in elderly patients with chronic coronary artery disease and heart failure.
Non-emergent complex PCI performed on elderly patients
Comparison of outcomes with and without mechanical circulatory support
Follow-up included 30 days and 90 days post-procedure
At 30 days, all-cause mortality was higher in the MCS group (10.3% vs 5.3%; HR 2.04, 95% CI 1.59-2.61)
Cardiogenic shock incidence was also greater in the MCS cohort (6.3% vs 2.5%; HR 2.61, 95% CI 1.84-3.68)
Mortality remained elevated in the MCS group among day-7 survivors through day 90 (HR 1.42, 95% CI 1.08-1.86).

Study Design

Type

Observational

Structured PICO

Does Impella support improve outcomes in elderly patients (≥70 years) with HFrEF undergoing non-emergent PCI for chronic CAD?

Population

Adults aged ≥70 years with HFrEF undergoing non-emergent PCI for chronic CAD without baseline cardiogenic shock. Mean age 77.5±4.9 years, 73% male.

Intervention

Impella mechanical circulatory support

Comparator

No Impella support (1:1 propensity score-matched)

Outcome

MACE (composite of all-cause mortality, ST-elevation myocardial infarction, non-ST-elevation myocardial infarction, and ischemic stroke) at 7, 30, and 90 dayscomposite

In elderly patients with HFrEF undergoing non-emergent PCI, Impella use was associated with higher mortality, cardiogenic shock, and bleeding, likely reflecting rescue use in more complex or unstable cases.

Main Result

Effect estimate: HR 0.99 (95% CI 0.90-1.09)

Absolute Event Rate: 46.4% vs 45.7%

Limitations

Findings may reflect unmeasured confounding from rescue MCS deployment in patients with intraprocedural hemodynamic instability or greater procedural complexity.

Abstract

616.6%).At 30 days, MACE was similar between groups (46.4% vs 45.7%; HR 0.99, 95% CI 0.90-1.09).All-cause mortality (10.3% vs 5.3%; HR 2.04, 95% CI 1.59-2.61)and cardiogenic shock (6.3% vs 2.5%; HR 2.61, 95% CI 1.84-3.68)were observed to be higher in the MCS cohort.These observations were consistent at 7 days (mortality HR 3.18, 95% CI 2.20-4.61;cardiogenic shock HR 2.95, 95% CI 1.92-4.53).Among day-7 survivors, mortality remained higher in the MCS group through day 90 (HR 1.42, 95% CI 1.08-1.86).Sensitivity analysis yielded Evalues of 3.50 for 30-day mortality, suggesting moderate robustness to unmeasured confounding.Conclusions: In non-emergent complex PCI without baseline shock, MACE was similar regardless of MCS use.However, all-cause mortality and cardiogenic shock were observed to be higher in the MCS cohort, with this signal persisting among day-7 survivors.These findings may reflect rescue MCS deployment in patients with intraprocedural hemodynamic instability or greater procedural complexity.Prospective randomized trials are needed to define optimal patient selection and timing for MCS.

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