Key result
Protected PCI with Impella offers a viable alternative for high-risk patients ineligible for CABG.
Why the study?
Does protected PCI with mechanical assistance devices like Impella improve clinical outcomes in high-risk patients with complex CAD and depressed LV function who are ineligible for CABG?
Does protected PCI with mechanical assistance devices like Impella improve clinical outcomes in high-risk patients with complex CAD and depressed LV function who are ineligible for CABG?
Protected PCI using mechanical circulatory support like Impella may be a viable alternative for high-risk patients with complex CAD and depressed LV function who are ineligible for CABG.
Caution against routine adoption; leaves open the need for RCTs on protected PCI in high-risk CABG-ineligible patients.
Patients with left main or multivessel coronary artery disease (CAD) and depressed left ventricular function undergoing coronary artery by-pass grafting (CABG) have a markedly worse prognosis compared with general population. As a consequence, these patients are often refused for surgical revascularization. At the same time, surgical ineligibility is associated with poor clinical outcome when these patients are referred for percutaneous coronary intervention (PCI). However, recent studies suggest that a revascularization strategy with a protected percutaneous coronary intervention (PCI) using a mechanical assistance device may be a viable alternative. In particular, the development of percutaneous left ventricular assist devices such as Impella has been an important step to facilitate the care of these high-risk patients. In this review we discuss about conditions for surgical ineligibility and the clinical outcome of PCI in high-risk patients ineligible for surgery. Moreover, we discuss about the evidences supporting the use of Impella in high-risk patients ineligible for surgery.
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Montone et al. (2018) conducted a review in Left main or multivessel coronary artery disease with depressed left ventricular function. Protected percutaneous coronary intervention (PCI) using Impella was evaluated. Protected percutaneous coronary intervention using mechanical assistance devices like Impella may be a viable alternative for high-risk patients ineligible for surgical revascularization.
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