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Indication and short-term clinical outcomes of high-risk percutaneous coronary intervention with microaxial Impella® pump: results from the German Impella® registry

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Abstract

Background

Percutaneous coronary intervention (PCI) is an alternative strategy to coronary artery bypass grafting (CABG) in patients with high perioperative risk. The microaxial Impella® pump (Abiomed, Danvers, MA, USA), used as prophylactic and temporary support, is currently the most common device for “protected high-risk PCI” to ensure hemodynamic stability during complex coronary intervention.

Methods

The study is an observational, retrospective multi-center registry. Patients from nine tertiary hospitals in Germany, who have undergone protected high-risk PCI, are included in the present study.

Results

A total of 154 patients (mean age 72.6–10.8 years, 75.3% male) were enrolled. The majority were at a high operative risk illustrated by a logistic EuroSCORE of 14.7–17.4. The initial SYNTAX score was 32.0–13.3, indicating very complex CAD and could be reduced to 14.1–14.3 (p < 0.0001) after PCI. The main reasons for protected PCI were complex coronary anatomy (70.8%), personal impression (56.5%), reduced ventricular ejection fraction (49.4%), comorbidities (47.4%), and surgical turndown (30.5%). Four patients (2.6%) experienced an intrahospital death.

Conclusions

Data from the study show that protected PCI is a safe and effective approach to revascularize high-risk patients with complex coronary anatomy and comorbidities.

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Abbreviations

CAD:

Coronary artery disease

CABG:

Coronary artery bypass graft

eGFR:

Estimated glomerular filtration rate

IABP:

Intra-aortic balloon pump

IQR:

Interquartile range

LAD:

Left anterior descending

LCX:

Left circumflex artery

LMT:

Left main trunk

LV:

Left ventricle

MACE:

Major adverse cardiac event

pLVAD:

Percutaneous left ventricular assist device

RCA:

Right coronary artery

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Acknowledgements

Supported by the DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung-German Centre for Cardiovascular Research).

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Authors and Affiliations

  1. First Department of Medicine-Cardiology, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    Stefan Baumann, Tobias Becher & Ibrahim Akin

  2. DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Mannheim, Germany

    Stefan Baumann, Tobias Becher & Ibrahim Akin

  3. Department of Internal Medicine II, Rheinische Friedrich-Wilhelms University, Bonn, Germany

    Nikos Werner & Jan-Malte Sinning

  4. Technische Universität Dresden, Heart Center Dresden, University Hospital Dresden, Dresden, Germany

    Karim Ibrahim

  5. Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany

    Ralf Westenfeld

  6. The Department of Cardiology and Vascular Medicine of the West-German Heart and Vascular Center Essen, Essen University Hospital, University Duisburg-Essen, Essen, Germany

    Fadi Al-Rashid

  7. Department of General and Interventional Cardiology, University Heart Centre Hamburg Eppendorf, Hamburg, Germany

    Dirk Westermann

  8. Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany

    Andreas Schäfer

  9. Department of Internal Medicine-Cardiology, Philipps University of Marburg, Marburg, Germany

    Konstantinos Karatolios

  10. Department of Cardiology, University Clinic Giessen, Giessen, Germany

    Timm Bauer

Authors
  1. Stefan Baumann
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  2. Nikos Werner
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  3. Karim Ibrahim
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  4. Ralf Westenfeld
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  5. Fadi Al-Rashid
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  6. Jan-Malte Sinning
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  7. Dirk Westermann
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  8. Andreas Schäfer
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  9. Konstantinos Karatolios
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  10. Timm Bauer
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  11. Tobias Becher
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  12. Ibrahim Akin
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Corresponding author

Correspondence to Ibrahim Akin.

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Conflict of interest

SB, NW, KI, RW, FAR, JMS, AS, KK, and IA receive consulting fees/honoraria from Abiomed (Danvers, MA, USA). All other authors declare that they have no financial disclosures.

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Baumann, S., Werner, N., Ibrahim, K. et al. Indication and short-term clinical outcomes of high-risk percutaneous coronary intervention with microaxial Impella® pump: results from the German Impella® registry. Clin Res Cardiol 107, 653–657 (2018). https://doi.org/10.1007/s00392-018-1230-6

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  • DOI: https://doi.org/10.1007/s00392-018-1230-6

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