Role of Mechanical Circulatory Support in High-Risk Patients Undergoing Percutaneous Coronary Intervention
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SECONDARY PREVENTION AND INTERVENTION (D. STEINBERG, SECTION EDITOR)
Role of Mechanical Circulatory Support in High-Risk Patients Undergoing Percutaneous Coronary Intervention Prasanna Sengodan 1 & Adeel Siddiqui 2 & Ashesh N. Buch 2,3
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review The risk of coronary interventions has fallen despite a temporal increase in complexity. However, patients with multiple comorbidities, complex coronary anatomy, and hemodynamic instability who are a high-risk subgroup that need revascularization are not well studied. Our review focuses on the role of mechanical circulatory support (MCS) in high-risk percutaneous coronary intervention (HR-PCI). Recent Findings Among the MCS devices, intra-aortic balloon pump (IABP) and Impella have been most studied, albeit with limited randomized controlled trial data. There is no unequivocal evidence of hard clinical benefit with the use of these devices in HR-PCI. Recent large observational studies have shown a signal of harm with current usage patterns in the USA with wide variation in the use of MCS devices among people undergoing percutaneous coronary intervention (PCI). Better defining which patients will obtain a net clinical benefit from MCS-supported PCI is required. Summary Optimal patient and proper device selection is of paramount importance to achieve the best outcomes. The use of MCS devices in percutaneous coronary intervention (PCI) should largely be reserved for patients with high SYNTAX scores and EF < 30% that will undergo treatment of longer lengths of disease with atherectomy or have an anticipated long treatment duration and importantly also have a low risk of harm from large bore access for MCS implantation. Keywords Mechanical circulatory support . High-risk percutaneous coronary intervention . Intra-aortic balloon pump . Impella . Extracorporeal membrane oxygenation
Abbreviations MCS Mechanical circulatory support IABP Intra-aortic balloon pump counterpulsation HR-PCI High-risk percutaneous coronary intervention CHIP Complex high-risk indicated patients/procedures MACCE Major adverse cardiac and cerebrovascular events ECMO Extracorporeal membrane oxygenation
This article is part of the Topical Collection on Secondary Prevention and Intervention * Ashesh N. Buch [email protected]; [email protected] 1
Division of Cardiology, Brody School of Medicine at East Carolina University, Greenville, NC, USA
2
Division of Cardiology, Interventional Cardiology, Brody School of Medicine at East Carolina University, Greenville, NC, USA
3
Department of Cardiovascular Sciences, Brody School of Medicine at East Carolina University, 115 Heart Dr, Greenville, NC 27834, USA
LVEF NYHA ITT PP AKI PHP NCDR UPLMS/ LMS LV
Left ventricular ejection fraction New York Heart Association Intention-to-treat Per protocol Acute kidney injury Percutaneous heart pump National Cardiovascular Data Registry Unprotected left main stem/left main stem Left ventricle
Introduction Over the last 10–15 years, in
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