Key result
Impella-supported high-risk PCI is linked to ~5 mmHg lower LVEDP versus unprotected PCI.
Why the study?
The decision to use percutaneous mechanical circulatory support in elective HRPCI is complex, prompting evaluation of LVEDP to identify patients who may benefit.
Does Impella CP mechanical circulatory support reduce left ventricular end-diastolic pressure (LVEDP) and correlate with 24-hour renal and cardiac biomarkers in patients with LVEF ≤35% undergoing elective high-risk PCI?
Cohort (n=62)
Yes
Does Impella CP mechanical circulatory support reduce left ventricular end-diastolic pressure (LVEDP) and correlate with 24-hour renal and cardiac biomarkers in patients with LVEF ≤35% undergoing elective high-risk PCI?
In patients with LVEF ≤35% undergoing elective high-risk PCI, Impella CP support significantly lowers LVEDP during the procedure compared to unprotected PCI, though without impacting 24-hour cardiac/renal biomarkers or 90-day MACCE rates.
Answers are grounded in this paper and cite their sources.
May support Impella for acute LVEDP reduction in high-risk PCI; leaves open biomarker and outcome relevance.
Background: The decision-making process to use percutaneous mechanical circulatory support in the context of elective high-risk percutaneous coronary intervention (HRPCI) is complex and evolving. The aim of this study is to evaluate the left ventricular end-diastolic pressure (LVEDP) as a parameter to identify patients that may benefit from a protected HRCPI (pHRPCI) procedure. Methods: Overall, 62 patients (pHRPCI n = 31 vs. non-pHRPCI n = 31) with a complex coronary artery disease and a left ventricular ejection fraction (LVEF) ≤35% were included. The primary endpoint was defined as a change in LVEDP and its correlation with laboratory measurements. The secondary safety endpoint was a composite of the incidence of major in-hospital adverse cardiac and cerebrovascular events (MACCE). Results: Baseline characteristics were similar, including age (pHRPCI 72.8 ± 8.8 vs. non-pHRPCI 75.0 ± 10.4; p = 0.408), male (pHRPCI 83.9% vs. non-pHRPCI 96.8; p = 0.195), pre-PCI Syntax Score (pHRPCI 33.9 ± 13.1 vs. non-pHRPCI 35.4 ± 12; p = 0.643), post-PCI Syntax Score (pHRPCI 7.4 ± 6.2 vs. non-pHRPCI 9.6 ± 8.4; p = 0.239) and baseline LVEDP between the groups (pHRPCI 18.5 ± 10.5 mmHg vs. non-pHRPCI 15.7 ± 8.1 mmHg; p = 0.237). There was a trend to a lower LVEF in the pHRPCI group (26.4 ± 6.7% vs. 29.4 ± 5%; p = 0.051). The primary endpoint analysis revealed a significant change in LVEDP (pHRPCI −4.7 ± 9 mmHg vs. non-pHRPCI +3.1 ± 7.5 mmHg; p < 0.001) that did not correlate with changes in creatinine (p = 0.285), NT-proBNP (p = 0.383) or troponin (p = 0.639) concentrations within 24 h. Overall, low rates of in-hospital (pHRPCI 6.5% vs. non-pHRPCI 3.2%; p = 0.999) and 90-days (pHRPCI 12.9% vs. non-pHRPCI 12.9%; p = 0.999) MACCE were observed in both groups. Conclusions: Protected HRPCI leads to a significant reduction in LVEDP without influencing biomarkers of myocardial damage. There was no difference in MACCE rates between the groups.
No takes yet. Share an insight, caveat, or question.
Leick et al. (2025) conducted a cohort in Complex coronary artery disease with LVEF ≤35% undergoing elective high-risk PCI (n=62). Impella CP Smart Assist (protected high-risk PCI) vs. Unprotected high-risk PCI without percutaneous mechanical circulatory support was evaluated on Change in left ventricular end-diastolic pressure (LVEDP; baseline minus post-PCI) and its correlation with 24-hour laboratory markers (creatinine, hs-cTnT, NT-proBNP) (p=<0.001). Protected high-risk PCI with Impella support significantly reduced LVEDP compared to unprotected PCI (-4.7 vs +3.1 mmHg; p<0.001) without correlating with 24-hour cardiac or renal biomarkers.
Synapse has enriched 10 related papers. Consider them for comparative context: