Differential characteristics and outcomes of women and men undergoing Impella-supported high-risk PCI: IMPELLA-PL registry

BACKGROUND: Impella (Abiomed, Danvers, MA, USA) is a mechanical circulatory support device to prevent haemodynamic compromise in selected patients undergoing high-risk percutaneous coronary interventions. OBJECTIVES: Data on sex differences in the setting of Impella-assisted high-risk percutaneous coronary interventions are limited. This analysis compared the characteristics and outcomes of women and men supported with Impella CP during high-risk percutaneous coronary interventions. METHODS: Consecutive patients enrolled in the IMPELLA-PL registry, undergoing high-risk percutaneous coronary interventions from January 2014 until December 2021, with 12-month follow-up until December 2022, were included in the analysis. The main endpoints included (i) In-hospital mortality, (ii) Periprocedural complications, (iii) 12-month mortality, and major adverse cardiovascular events following hospital discharge. RESULTS: Among 253 patients analyzed, women (12.6 %) were older (75.2 ± 7.7 years vs. 70.1 ± 10.0, p = 0.006), had more left main disease (81.2 % vs. 61.1 %, p = 0.043), and higher Syntax Score (46.0 vs. 42.5, p = 0.038). The in-hospital mortality rate was comparable between groups (9.4 % vs. 8.1 %, p = 0.736). Women experienced fewer device-related complications (6.3 % vs. 20.8 %, p = 0.049), but more systemic complications (68.8 % vs. 35.7 %, p < 0.001). Women trended towards lower 12-month mortality (9.4 % vs. 19.4 %, p = 0.053), while post-discharge major adverse cardiovascular events (15.6 % vs. 23.5 %, p = 0.439) were comparable. CONCLUSIONS: Women and men undergoing Impella-assisted high-risk percutaneous coronary interventions have comparable in-hospital mortality rates, but different complication profiles. Following hospital discharge, the 12-month survival rate appears to be higher in women, despite more advanced age and a greater complexity of coronary artery disease.