High-Risk Percutaneous Coronary Intervention of Native Coronary Arteries Without Mechanical Circulatory Support in Acute Coronary Syndrome Without Cardiogenic Shock
Section snippets
Methods
All patients with ACS – unstable angina pectoris (UAP), non-ST-elevation myocardial infarction (NSTEMI), and ST-elevation myocardial infarction (STEMI) – undergoing high-risk PCI at MedStar Washington Hospital Center, Washington, District of Columbia, United States (US), from 2003 through 2018 were included in this analysis. High-risk PCI was defined as patients meeting 1 or more of the contemporary criteria described by the Interventional Scientific Council of the ACC:1 unprotected LMCA
Results
A total of 499 patients (847 lesions) with UAP, 1218 patients (1807 lesions) with NSTEMI, and 868 patients (1260 lesions) with STEMI who met the predefined high-risk PCI criteria were included in the analysis. Patients meeting eligibility criteria but presenting with stable ischemic heart disease or cardiogenic shock or undergoing PCI of bypass grafts were excluded. Additionally, 13 patients presenting with UAP, 58 with NSTEMI, and 101 with STEMI received elective IABP before PCI and were also
Discussion
Our analysis demonstrates that in patients presenting with ACS meeting high-risk criteria, the strategy of PCI without elective MCS is: a) Feasible and safe in the majority of patients presenting with UAP and NSTEMI, with a low rate of bailout MCS; b) Associated with a higher number of bailout MCS in patients presenting with STEMI; c) Associated with higher mortality in STEMI patients in comparison with the other groups; and d) Associated with a low incidence of major complications (except for
Disclosures
Toby Rogers – Proctor and Consultant: Medtronic, Edwards Lifesciences; Advisory Board: Medtronic; Equity interest: Transmural Systems.
Ron Waksman – Advisory Board: Abbott Vascular, Amgen, Boston Scientific, Cardioset, Cardiovascular Systems Inc., Medtronic, Philips, Pi-Cardia Ltd.; Consultant: Abbott Vascular, Amgen, Biotronik, Boston Scientific, Cardioset, Cardiovascular Systems Inc., Medtronic, Philips, Pi-Cardia Ltd., Transmural Systems; Grant Support: AstraZeneca, Biotronik, Boston
References (16)
- et al.
A practical approach to mechanical circulatory support in patients undergoing percutaneous coronary intervention: an interventional perspective
JACC Cardiovasc Interv
(2016) - et al.
2015 SCAI/ACC/HFSA/STS Clinical expert consensus statement on the use of percutaneous mechanical circulatory support devices in cardiovascular care: endorsed by the American Heart Assocation, the Cardiological Society of India, and Sociedad Latino Americana de Cardiologia Intervencion; Affirmation of value by the Canadian Association of Interventional Cardiology-Association Canadienne de Cardiologie d'intervention
J Am Coll Cardiol
(2015) - et al.
High-risk PCI in acute coronary syndromes with Impella LP 2.5 device support
Int J Cardiol
(2011) - et al.
A prospective, randomized evaluation of prophylactic intraaortic balloon counterpulsation in high risk patients with acute myocardial infarction treated with primary angioplasty. Second Primary Angioplasty in Myocardial Infarction (PAMI-II) Trial Investigators
J Am Coll Cardiol
(1997) - et al.
Feasibility and safety of high-risk percutaneous coronary intervention without mechanical circulatory support
Circ Cardiovasc Interv
(2021) - et al.
2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention: executive summary
Circulation
(2011) - NCDR CathPCI Registry Data Coder's Dictionary v5.0. Available...
- et al.
Intra-aortic balloon counterpulsation and infarct size in patients with acute anterior myocardial infarction without shock: the CRISP AMI randomized trial
JAMA
(2011)
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Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.