Does Impella support improve outcomes in women with HFrEF undergoing non-emergent PCI for chronic CAD without baseline cardiogenic shock?
In women with HFrEF undergoing non-emergent PCI for chronic CAD, Impella use was associated with higher rates of mortality, cardiogenic shock, and bleeding, likely reflecting rescue use for intraprocedural instability.
616.6%).At 30 days, MACE was similar between groups (46.4% vs 45.7%; HR 0.99, 95% CI 0.90-1.09).All-cause mortality (10.3% vs 5.3%; HR 2.04, 95% CI 1.59-2.61)and cardiogenic shock (6.3% vs 2.5%; HR 2.61, 95% CI 1.84-3.68)were observed to be higher in the MCS cohort.These observations were consistent at 7 days (mortality HR 3.18, 95% CI 2.20-4.61;cardiogenic shock HR 2.95, 95% CI 1.92-4.53).Among day-7 survivors, mortality remained higher in the MCS group through day 90 (HR 1.42, 95% CI 1.08-1.86).Sensitivity analysis yielded Evalues of 3.50 for 30-day mortality, suggesting moderate robustness to unmeasured confounding.Conclusions: In non-emergent complex PCI without baseline shock, MACE was similar regardless of MCS use.However, all-cause mortality and cardiogenic shock were observed to be higher in the MCS cohort, with this signal persisting among day-7 survivors.These findings may reflect rescue MCS deployment in patients with intraprocedural hemodynamic instability or greater procedural complexity.Prospective randomized trials are needed to define optimal patient selection and timing for MCS.
Abdelmaksoud et al. (Wed,) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: