Author + information
- S1936879815020609-8a0d83c4defd40a95174b9636fbf703aAnisha Rastogi,
- S1936879815020609-a5a908cfb86eb3fce07c78e69c20ba79Meena Narayanan,
- S1936879815020609-4d352f7b9747aad55d01862c31e8e7d1Rajan Shah,
- S1936879815020609-4ad91e595990bf1dda8fcdba1746f861Anilkumar Mehra,
- S1936879815020609-36dc6d39f153d8b7694abff78d43d9d2David Shavelle,
- S1936879815020609-d54a419011ec9134c195704db787dd08Ray Matthews and
- S1936879815020609-6f602475989092ce09105667b5679d08Leonardo Clavijo
In patients undergoing high risk percutaneous coronary intervention (PCI) a percutaneous left ventricular support device is often used, especially in unprotected left main (ULM) disease. For these patients, we sought to determine if there is an impact of device support use on short and long term mortality.
We performed a retrospective study of 71 patients who were deemed high risk for surgery and subsequently underwent PCI of ULM disease at Keck School of Medicine (4/2008-6/2014). Patients were divided based on support: none (n=17), lower level support [intra-aortic balloon pump (IABP) support (n=33)] vs. high level of support [Tandom Heart (TH) or Impella support (n=21)].
71 patients underwent high-risk PCI after being denied surgical revascularization (mean age 69.61+/-13.5 years, 45 male and 26 female). When evaluating patients based on extent of coronary disease defined by syntax score and by risk profile defined by STS or euroSCORE II, there was no statistically significant correlation with support device used. The mean ejection fraction (EF) was significantly higher in the no support and low level support groups (45+/-15 and 46+/-15, respectively) than the high level support group (34+/-14, p<0.01). Patients with any support used were more likely to have an ejection fraction of 50% than the patient who had high level support used (41.18% vs 35.19%). Furthermore, use of no support vs. any support showed no statistically significant difference in regards to in-hospital mortality (5.88% vs. 7.4%, p=1.0), 30 day mortality (5.88% vs. 7.4%, p=1.0), and 1 year mortality (17.65.0% vs. 24.07%, p=0.87).
In patients with ULM disease deemed surgically high risk and undergoing PCI, there is no significant difference in regards to in-hospital, 30 day, and 1 year mortality in patients who had no support device used versus patients who had a support device used, despite similar high risk profiles determined by syntax, STS, and euroSCORE II. Furthermore, patients with EF <30% are more likely to have device support used when undergoing intervention of ULM disease. However, despite the complexity of coronary disease, these patients can be safely managed without the use of high support devices if they have a preserved ejection fraction.