In patients undergoing high-risk PCI, Impella mechanical circulatory support was associated with a lower 1-year rate of myocardial infarction (1.4% vs. 10.9%, p=0.003) compared to no support.
Cohort (n=276)
Yes
Does Impella-assisted mechanical circulatory support improve 1-year clinical outcomes in patients undergoing high-risk percutaneous coronary interventions compared to PCI without support?
Impella-assisted high-risk PCI may reduce the risk of subsequent myocardial infarction and heart failure rehospitalization at 1 year compared to unsupported PCI, though randomized trials are needed to confirm these observational findings.
Absolute Event Rate: 1.4% vs 10.9%
p-value: p=0.003
BACKGROUND: Impella is increasingly used as mechanical circulatory support (MCS) during high-risk percutaneous coronary interventions (HR-PCI). Registry-based data provide insights into the efficacy and safety of Impella-assisted HR-PCI. AIMS: We aimed to evaluate 1-year outcomes of Impella-assisted HR-PCI compared to HR-PCI without MCS. METHODS: One hundred and thirty-eight patients undergoing Impella-assisted PCI, included in the IMPELLA-PL registry, were propensity score-matched with controls from the retrospective CardioSilesia registry who underwent HR-PCI without MCS. Study endpoints included 1-year post-discharge all-cause mortality, myocardial infarction (MI), stroke, rehospitalization for heart failure (HF), and repeat coronary revascularization. RESULTS: Clinical and angiographic characteristics were comparable in both groups, with higher rates of dyslipidemia (78.3% vs. 37.7%, p < 0.001), chronic kidney disease (39.9% vs. 16.7%, p < 0.001), and peripheral artery disease (34.1% vs. 8.0%, p < 0.001) in the IMPELLA-PL cohort. Intravascular ultrasound was more frequently used in the Impella-supported patients (44.2% vs. 25.4%, p = 0.002), while staged revascularization was more common among controls (30.4% vs. 15.9%, p = 0.007). At 1 year, rates of post-discharge all-cause mortality, stroke, and repeat coronary revascularization were similar in both groups. MI was less frequent in the IMPELLA-PL cohort (1.4% vs. 10.9%, p = 0.003), alongside a trend toward lower incidence of rehospitalizations for HF (9.4% vs. 18.1%, p = 0.055). CONCLUSIONS: Despite an unfavorable cardiovascular risk profile, patients who underwent Impella-assisted HR-PCI had similar 1-year post-discharge survival, with a lower rate of MI, compared to propensity score-matched controls who underwent HR-PCI without MCS. Impella may improve HR-PCI outcomes in selected patients, but further randomized controlled trials are required to confirm this finding.
Gąsecka et al. (2026) conducted a cohort in High-risk percutaneous coronary interventions (HR-PCI) (n=276). Impella mechanical circulatory support vs. HR-PCI without mechanical circulatory support was evaluated on Myocardial infarction at 1 year post-discharge (p=0.003). In patients undergoing high-risk PCI, Impella mechanical circulatory support was associated with a lower 1-year rate of myocardial infarction (1.4% vs. 10.9%, p=0.003) compared to no support.