What happened
Elective LV unloading shows no benefit for major outcomes at 12 months in complex PCI.
Three clinicians conclude that routine use of pump support during high-risk PCI is not justified by these results. They call for reconsidering routine use or moving to a more selective approach.
Experts read CHIP-BCIS3 as a negative trial with signs of harm, and they say routine pump support during complex coronary procedures in patients with weak hearts should not be recommended.
Commentators agree the trial showed no benefit from routinely unloading the heart with a pump and may have shown harm. The trial's own investigators were surprised that the pump did not protect the heart muscle, and an economic analysis found the strategy costlier and worse for quality of life. The live question is how much more selective use should become, especially for patients who are not unstable.
Experts point to patients with clear hemodynamic instability and to cardiogenic shock, where support has better data, as settings this trial does not settle.
How far use should be scaled back in high-risk PCI outside those settings is still open.
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“There’s been a huge growth in what’s been termed ‘protected PCI,’ and although we have very good data in cardiogenic shock, probably more than 75% of all implants have been in the high-risk PCI setting rather than in shock. These results will give pause for thought in that we need to reconsider routine use of it.”
Divaka Perera, MD ↗From published coverage, not an answer posted here.
Roxana Mehran
Practice takeInterventional cardiologist, Icahn School of Medicine at Mount Sinai“CHIP-BCIS3 tells us that there is no benefit and possibly some harm. Routine use of this strategy cannot be recommended.”
Mehran reads CHIP-BCIS3 as showing no benefit and possibly some harm. She concludes that routine use of this strategy cannot be recommended.
Brahmajee K. Nallamothu
Practice takeCardiologist, University of MichiganThe data support a more selective use of mechanical circulatory support in high-risk PCI.
Nallamothu says the investigators provide enough data to encourage a more selective approach to mechanical circulatory support in high-risk PCI. He stresses this applies particularly when there is no clear hemodynamic instability.
Holly Morgs
Results readoutCardiologist and researcher, King's College London“I was delighted to present the prespecified health economic analysis of @CHIP_BCIS3 at #TCT2026 At 1 year, elective mAFP use in high-risk PCI increased healthcare costs (£18,989), reduced QALYs and had a 0% probability of cost-effectiveness With thanks to @LSHTM & our patients!”
Morgs presented the prespecified health economic analysis. At 1 year, elective mAFP use in high-risk PCI increased healthcare costs by £18,989, reduced QALYs and had a 0% probability of being cost-effective.
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Why the trial, key points, tables, limitations, PICO, abstract, media & sources
Why the trial?
The CHIP-BCIS3 trial was conducted to address whether elective percutaneous left ventricular unloading with a microaxial flow pump improves outcomes in patients with severely impaired left ventricular function undergoing complex PCI, as this remains unclear.
Does elective left ventricular unloading with a microaxial flow pump improve clinical outcomes in patients with severe left ventricular dysfunction and extensive coronary artery disease undergoing complex PCI?
RCT (n=300)
1:1 ratio
Does elective left ventricular unloading with a microaxial flow pump improve clinical outcomes in patients with severe left ventricular dysfunction and extensive coronary artery disease undergoing complex PCI?
Expert reaction
NEJM · ACC Annual Scientific Session 2025
Expert labels are toward CHIP-BCIS3's result, from named public quotes (n=0). As of Oct 20, 2026.
Experts read CHIP-BCIS3 as a negative trial with signs of harm, and they say routine pump support during complex coronary procedures in patients with weak hearts should not be recommended.
Commentators agree the trial showed no benefit from routinely unloading the heart with a pump and may have shown harm. The trial's own investigators were surprised that the pump did not protect the heart muscle, and an economic analysis found the strategy costlier and worse for quality of life. The live question is how much more selective use should become, especially for patients who are not unstable.
Three clinicians conclude that routine use of pump support during high-risk PCI is not justified by these results. They call for reconsidering routine use or moving to a more selective approach.
1 take classified by contention axis so far — the map appears as more land.
Experts point to patients with clear hemodynamic instability and to cardiogenic shock, where support has better data, as settings this trial does not settle. How far use should be scaled back in high-risk PCI outside those settings is still open.
Elective left ventricular unloading with a microaxial flow pump during complex PCI in patients with severe LV dysfunction did not reduce major adverse clinical outcomes compared to standard care.
BACKGROUND: Complex percutaneous coronary intervention (PCI) in patients with severely impaired left ventricular function carries a high risk of death and complications. Whether percutaneous left ventricular unloading improves outcomes remains unclear. METHODS: We randomly assigned 300 patients with severe left ventricular dysfunction and extensive coronary artery disease in a 1:1 ratio to a strategy of elective unloading with a microaxial flow pump or to standard care during planned complex PCI. The primary outcome was a hierarchical composite that included death from any cause, disabling stroke, spontaneous myocardial infarction, hospitalization for cardiovascular causes, or periprocedural myocardial injury at a minimum of 12 months, as analyzed according to a win ratio. RESULTS: A total of 148 patients were assigned to receive a microaxial flow pump and 152 to receive standard care. At a median of 22 months (interquartile range, 16 to 30), 36.6% of pairwise comparisons favored the microaxial flow pump, and 43.0% favored standard care (win ratio, 0.85; 95% confidence interval [CI], 0.63 to 1.15; difference, -6.4 percentage points; P = 0.30). Death from any cause occurred in 47 patients in the microaxial-flow-pump group and 33 in the standard-care group (hazard ratio, 1.54; 95% CI, 0.99 to 2.41). There was no material between-group difference in the risk of bleeding or vascular complications. CONCLUSIONS: Among patients with severely impaired left ventricular function undergoing complex PCI, elective left ventricular unloading with a microaxial flow pump did not reduce the risk of major adverse clinical outcomes at a minimum of 12 months. (Funded by the U.K. National Institute for Health and Care Research; CHIP-BCIS3 ClinicalTrials.gov number, NCT05003817.).
Perera et al. (2026) conducted an RCT in severe left ventricular dysfunction and extensive coronary artery disease (n=300). elective unloading with a microaxial flow pump vs. standard care was evaluated on hierarchical composite that included death from any cause, disabling stroke, spontaneous myocardial infarction, hospitalization for cardiovascular causes, or periprocedural myocardial injury at a minimum of 12 months (win ratio 0.85, 95% CI 0.63-1.15, p=0.30). Elective left ventricular unloading with a microaxial flow pump during complex PCI did not improve major adverse clinical outcomes versus standard care (win ratio 0.85; 95% CI 0.63-1.15; P=0.30).
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