Use of Continuous Positive Airway Pressure Ventilation as a Support During Coronary Angioplasty in Patients with Acute Myocardial Infarction: Safety and Feasibility.

Background/Objectives: To evaluate the safety and feasibility of continuous positive airway pressure (CPAP) in patients with acute myocardial infarction (AMI) and acute decompensated heart failure (ADHF) during percutaneous coronary intervention (PCI). Non-invasive ventilation (NIV) is an established treatment for ADHF. Methods: All consecutive patients admitted to Santa Croce Hospital of Cuneo, receiving CPAP for ADHF in the cath lab during PCI for AMI, were included in a case series. Results: Between December 2018 and March 2021, 25 pts were included (median age 78 yrs, 48% female), with 64% of patients presenting with ST-elevation AMI and 17 (69%) in cardiogenic shock. At admission median left ventricular ejection fraction was 35 (20-60)% and eight (32%) patients had severe mitral regurgitation. Median PaO2/FiO2 was 183 (141-261) mmHg/%, lactate level 2.4 (1.3-3.8) mmol/L, and NTproBNP 7882 (3139-35,000) ng/L. CPAP was positioned and managed by nurses in all cases. Median FiO2 was 50 (35-100)% and median positive end-expiratory pressure was 7.5 (5-12) cmH2O. CPAP was generally well tolerated in 22 (88%) patients. One patient suffered cardiac arrest that led to CPAP interruption due to resuscitation maneuvers. No patient required orotracheal intubation in the cath lab. The post-procedural PaO2/FiO2 ratio substantially improved to 230 (175-356) mmHg/% (p = 0.007) and lactate decreased to 1.5 (1.0-1) mmol/L (p = 0.002). One patient died during hospital stay due to underlying disease, unrelated to the study procedure. Conclusions: CPAP during PCI in patients with AMI and ADHF seems feasible, safe, and well tolerated. Larger studies are warranted to confirm these results.