This retrospective multicenter registry evaluated the safety and feasibility of left
ventricular (LV) support with the Impella 2.5 (Abiomed Europe GmbH, Aachen, Germany)
during high-risk percutaneous coronary intervention (PCI).
Patients with complex or high-risk coronary lesions, such as last remaining vessel
or left main lesions, are increasingly being treated with PCI. Because periprocedural
hemodynamic compromise and complications might occur rapidly, many of these high-risk
procedures are being performed with mechanical cardiac assistance, particularly in
patients with poor LV function. The Impella 2.5, a percutaneous implantable LV assist
device, might be a superior alternative to the traditionally used intra-aortic balloon
pump.
The Europella registry included 144 consecutive patients who underwent a high-risk
PCI. Safety and feasibility end points included incidence of 30-day adverse events
and successful device function.
Patients were older (62% >70 years of age), 54% had an LV ejection fraction < or =
30%, and the prevalence of comorbid conditions was high. Mean European System for
Cardiac Operative Risk Evaluation score was 8.2 (SD 3.4), and 43% of the patients
were refused for coronary artery bypass grafting. A PCI was considered high-risk due
to left main disease, last remaining vessel disease, multivessel coronary artery disease,
and low LV function in 53%, 17%, 81%, and 35% of the cases, respectively. Mortality
at 30 days was 5.5%. Rates of myocardial infarction, stroke, bleeding requiring transfusion/surgery,
and vascular complications at 30 days were 0%, 0.7%, 6.2%, and 4.0%, respectively.
This large multicenter registry supports the safety, feasibility, and potential usefulness
of hemodynamic support with Impella 2.5 in high-risk PCI.