Case Review, Clinical Research & Data, Protected PCI
Protected PCI for Superior Long-Term Outcomes
In this special symposium on Protected PCI from the SCAI 2021 annual scientific session, a panel of interventional cardiologists discuss best practices for patient identification; tools and skills required to treat high-risk, complex, patients; and the importance of complete revascularization at the index procedure.
Laurette Mbuntum, MD, opens the discussion with a patient case that sets the stage for the other physicians to discuss appropriate patients and utilization of mechanical circulatory support (MCS). The case, which she titles “I Wish We Had Used an Impella,” highlights the issues of MCS use in aortic stenosis and revascularization strategies when faced with hemodynamic instability.
Next, Rajan Patel, MD, FACC, FAHA, FSCAI, discusses appropriate patient selection for high-risk PCI. After presenting a case, Dr. Patel describes the growing patient population appropriate for Protected PCI, noting that while over half of the nearly 2 million patients suffering from Class III/IV heart failure in the US have good target vessels for revascularization, only about a quarter of these patients are diagnosed with ischemic heart disease. “So, three-fourths of these patients with new onset heart failure,” he emphasizes, “are potentially not diagnosed with something that may be potentially reversible.”
Ehtisham Mahmud, MD, MACC, presents data on the efficacy of extensive revascularization at index PCI with Impella support and presents a case in which complete revascularization in a very symptomatic patient with low ejection fraction provided rapid and significant improvement. He reviews data from the PROTECT II RCT and PROTECT III trial that demonstrate how Impella use during high-risk PCI results in more extensive revascularization, and identifies factors to consider when deciding on the extent of revascularization during index PCI.
Alejandro Lemor, MD, continues the discussion of complete revascularization stating that while we know that complete revascularization is associated with better outcomes, “The question is how, when and with what?” He presents a case and discusses the tools needed for achieving complete revascularization, including hemodynamic support, image-and physiology guided PCI, vessel preparation, and complication management.
Next, Gregg Stone, MD, presents the potential benefits of MCS for high-risk PCI and describes the PROTECT IV study, which recently enrolled its first patient. PROTECT IV aims to test the hypothesis that by providing hemodynamic stability during high-risk, complex PCI, Impella will facilitate improved stent optimization and more complete revascularization that will translate into improved early and late outcomes.