Author + information
- Ali Abdul Jabbar1,
- Yaser Jbara2,
- Omar Mufti2,
- Omair Ali2,
- Ronald Markert2,
- David Joffe2 and
- Gary Fishbein2
Coronary artery bypass grafting is the standard of care for most patients with obstructive left main (LM) coronary disease. In poor surgical candidates, high-risk percutaneous coronary artery intervention (PCI) is a consideration. The results from randomized trials examining short-term mortality with the use of ventricular assist devices in high-risk PCI are controversial.
We investigated a retrospective cohort of patients who had LM PCI from January 2010 through March of 2014 (n = 89). Obstructive LM disease was 50% angiographic obstruction of the luminal flow, and the primary end-point was in-hospital mortality. Fisher's Exact Test was used to examine relationships. Inferences were made at the 0.05 level of significance. Ventricular assist device (VAD) is defined as the use of either IABP or Impella 2.5 device before, during, or following PCI.
The eighty-nine patients with LM PCI were divided into those with ventricular support (n=39) and without ventricular support (n=50). The former group was further divided into those with support from either Impella 2.5 (n=28) or intra-aortic balloon pump [IABP] (n=11).
Age, race, and gender did not differ between patients who received unassisted LM-PCI from those with ventricular support (P= 0.142, 1.0, and 0.776 respectively). The angiographic stenosis of atherosclerotic lesions in LM, proximal LAD, other native coronary vessels, vein grafts and bypasses were similar between the groups. Duration of hospitalization was significantly longer for patients with VAD support compared to those without VAD (7.19±6.89 vs. 2.78±3.39, p<0.001). The incidence of cardiogenic shock and in-hospital mortality was significantly higher in the VAD group (p=0.009 and 0.001 respectively).
Overall, in-hospital mortality was 9% (8 of 89). The IABP and Impella 2.5 groups had mortality proportions of 46% (5 of 11) and 11% (3 of 28), respectively; p = 0.028. For all patients, in-hospital mortality was higher for those with versus without cardiogenic shock (56% or 5 of 9 vs. 4% or 3 of 80; p < 0.001), and for those with versus without LVEF 40 (17% or 7 of 42 vs. 2% or 1 of 46; p < 0.025).
In a select group of patients with LM disease, unsupported PCI appears to be a feasible and safe procedure. In high-risk patients, the utilization of Impella 2.5 appears to be superior to IABP in LM PCI resulting in a favorable short-term mortality outcome.