Key result
Microaxial LV support in high-risk PCI linked to ~44% higher mortality and more bleeding.
Why the study?
Randomized evidence on the use of microaxial left ventricular support during nonemergent high-risk PCI is limited and device-related complications are a concern.
Does routine microaxial left ventricular support improve outcomes in patients undergoing nonemergent high-risk PCI?
Meta-Analysis
Does routine microaxial left ventricular support improve outcomes in patients undergoing nonemergent high-risk PCI?
Relative Risk: 1.44 (95% CI 1.05–1.97)
Current evidence does not support the routine prophylactic use of microaxial left ventricular support during nonemergent high-risk PCI due to increased major bleeding and lack of MACE or mortality benefit.
INTRODUCTION: Microaxial left ventricular support (MLVS; Impella, Abiomed) is increasingly used during nonemergent high-risk percutaneous coronary intervention (HR-PCI), although randomized evidence remains limited and device-related complications are a concern. METHODS: PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library were searched from inception through March 2026 for randomized and comparative observational studies of MLVS versus control during nonemergent HR-PCI. Random-effects meta-analysis, subgroup and sensitivity analyses, Bayesian modeling, risk-of-bias assessment, and GRADE were performed. RESULTS: = 82.1%). Exploratory analyses showed higher mortality estimates in randomized trials (RR 1.44, 95% CI 1.05-1.97) and studies of planned pre-PCI support (RR 1.52, 95% CI 1.17-1.97). Bayesian analysis yielded a median RR of 1.14 (95% CrI 0.80-1.65; Pr[RR >1]=77.2%). Myocardial infarction, stroke/cerebrovascular events, and MACE/MACCE were not significantly different, while major bleeding was increased (RR 1.92, 95% CI 1.14-3.23). CONCLUSIONS: Current evidence does not support routine prophylactic MLVS during nonemergent HR-PCI. Selective use may remain appropriate, but further adequately powered randomized trials are needed. PROTOCOL REGISTRATION: PROSPERO CRD420261358349.
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Mohamed et al. (2026) conducted a meta-analysis in nonemergent high-risk percutaneous coronary intervention. Microaxial left ventricular support (MLVS) vs. Control was evaluated on Mortality (in randomized trials) (RR 1.44, 95% CI 1.05-1.97). Microaxial left ventricular support during nonemergent high-risk PCI was associated with higher mortality in randomized trials (RR 1.44; 95% CI 1.05-1.97) and increased major bleeding.
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