OR2-3 | The Impact of Age in Patients Undergoing Impella-Assisted High-Risk Percutaneous Coronary Intervention: It Gets Complicated

The Impella ventricular assist device is often used in patients (pts) with complex coronary artery disease undergoing high-risk percutaneous coronary interventions (PCI). Limited data exits on the risks and benefits of these devices in elderly pts. Data was collected for quality control on pts undergoing Impella-assisted PCI. Pts were divided by age into three groups: ≤69, 70-79 and ≥80 years. Bleeding was classified by Bleeding Academic Research Consortium (BARC). MACCE was the composite of major bleeding (BARC ≥3), death, post-PCI MI and stroke. Between 2010 and 2018, 252 pts had Impella-assisted PCI (Table). Pts ≤69 were often male, presenting with STEMI or NSTEMI (61%) and had lower left ventricular ejection fraction (LVEF) complicated by shock (CS). Bleeding complications, mortality and MACCE were similar among the groups. Covariate adjustment for MACCE showed female sex (OR 3.2; CI: 1.6-6.2), STEMI (OR 3.7, CI: 1.6-8.5) and CS (OR 6.2, CI: 2.9-13.3) were associated with increased odds of MACCE. Pts ≥80 had 2.7-fold odds of MACCE compared to pts ≤69 (OR=2.7, CI: 1.2-6.1). In pts having Impella-assisted PCI: 1) indications for Impella varies across different ages; 2) younger pts (≤69) were healthier but in the midst of an acute coronary syndrome complicated by severely reduced LVEF and CS; 3) in-hospital BARC ≥3, mortality and MACCE were similar among the three groups; 4) by multivariable analysis, older age, female sex, STEMI and pre-PCI CS were independent predictors of MACCE; and 5) the odds of MACCE increased by almost 3-fold in pts ≥80 when compared to younger pts.