Comparative Outcomes of iVAC2L and IABP Support in High‐Risk PCI: Six‐Month Survival and Complication Analysis

Aims: This study aimed to compare 6‐month survival and complication rates of patients undergoing high‐risk percutaneous coronary intervention (PCI) supported by either iVAC2L mechanical circulatory support (MCS) or intra‐aortic balloon pump (IABP). Methods and Results: In this retrospective cohort analysis, we included 54 patients who underwent a high‐risk PCI for an unprotected left main, 3‐vessel disease or a last remaining vessel stenosis with temporary MCS. Patients received either iVAC2L ( n = 24) or IABP ( n = 30) during PCI. The primary endpoint was 6‐month all‐cause mortality. Secondary endpoints included vascular complications, repeat revascularization, and stroke. The groups had similar baseline characteristics, with the ejection fraction being 34.4 ± 9.5% in the iVAC2L group and 37.9 ± 9.4% in the IABP group ( p = 0.177). The 6‐month mortality rate was lower in the iVAC2L group (8.3%) compared to the IABP group (16.7%), though the difference was not statistically significant ( p = 0.365). Access site vascular complications were numerically higher in the iVAC2L group (12.5% vs. 3.3%; p = 0.201). Repeat revascularization rates (iVAC2L 4.2% vs. IABP 6.7%, p = 0.690) and stroke rates (iVAC2L 4.2% vs. IABP 3.3%, p = 0.872) were similar in both groups. Conclusion: Patients with iVAC2L MCS had higher 6‐month survival compared to IABP in high‐risk PCI, albeit without statistically significant differences. Both devices provided effective hemodynamic support during the intervention with no periprocedural mortality. Vascular complications were numerically more frequent with iVAC2L, highlighting the need for skilled vascular access management. Larger prospective studies are needed to confirm these findings and guide optimal MCS device selection for high‐risk PCI.