Clinical Research & Data, Protected PCI

Trends in Outcomes of High-Risk pVAD-Assisted PCI

 

Alejandro Lemor, MD, MS, discusses his paper titled “Trends in the Outcomes of High-risk Percutaneous Ventricular Assist Device-assisted Percutaneous Coronary Intervention, 2008-2018” published in the October 2021 issue of The American Journal of Cardiology. Dr. Lemor is an interventional cardiologist at Henry Ford Hospital in Detroit, Michigan.

This research evaluated trends in patient and procedural characteristics and complication rates in more than 26,000 patients undergoing pVAD-assisted PCI (excluding IABP) between 2008 and 2018. These were patients who did not have cardiogenic shock and who were identified from the National Inpatient Sample (NIS) database.

“Our primary finding was that we saw a 27-fold increase in the use of pVAD PCI in the United States in a 10-year period,” Dr. Lemor explains. “And we saw also higher use of atherectomy and image-guided PCI. We saw a sicker population. Definitely more comorbidities in the patients that we’re treating nowadays. And we saw a decreased rates of acute stroke and blood transfusion and steady rates of vascular complications and acute kidney injury among this population.”

Looking at Figure 1 from the paper, which graphically depicts the steady increase in the use of pVADs in high-risk PCI, Dr. Lemor explains that interventional cardiologists become more comfortable with using mechanical circulatory support (MCS) devices as more data becomes available.

“Everything is about safety,” Dr. Lemor states, as he reviews trends in procedural characteristics. He explains that having the support from MCS devices allows interventionalists adequate time to treat vessels in a controlled environment. “These are not simple PCIs,” he emphasizes, describing that these patients had low EF, bifurcations, and/or calcified lesions, and how MCS enabled increased use of atherectomy, image-guided PCI, and multivessel intervention, all of which significantly increased in use between 2008 and 2018.

Examining the trends in complications after pVAD-assisted PCI, Dr. Lemor highlights decreased rates of blood transfusion and acute stroke and a non-significant increase in mortality adjusted over the study period for comorbidities and age. “So we’re taking more patients, more sick patients into these procedures where the mortality has remained the same.”

Concluding with advice for today’s physicians, Dr. Lemor emphasizes the importance of keeping periprocedural mortality and complications low by developing comfort and expertise with PCI as well as vascular access and closure to ensure best outcomes for patients.

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