Author + information
- Anisha Rastogi,
- Meena Narayanan,
- Rajan Shah,
- Anilkumar Mehra,
- David Shavelle,
- Ray Matthews and
- Leonardo 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.