1. Hemodynamic Support With a Microaxial Percutaneous Left Ventricular Assist Device (Impella) Protects Against Acute Kidney Injury in Patients Undergoing High-Risk Percutaneous Coronary Intervention.
- Author
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Flaherty MP, Pant S, Patel SV, Kilgore T, Dassanayaka S, Loughran JH, Rawasia W, Dawn B, Cheng A, and Bartoli CR
- Subjects
- Acute Kidney Injury etiology, Aged, Female, Heart-Assist Devices adverse effects, Humans, Male, Middle Aged, Percutaneous Coronary Intervention adverse effects, Postoperative Complications etiology, Retrospective Studies, Risk Factors, Treatment Outcome, Acute Kidney Injury prevention & control, Heart-Assist Devices trends, Hemodynamics physiology, Percutaneous Coronary Intervention trends, Postoperative Complications prevention & control
- Abstract
Rationale: Acute kidney injury (AKI) is common during high-risk percutaneous coronary intervention (PCI), particularly in those with severely reduced left ventricular ejection fraction. The impact of partial hemodynamic support with a microaxial percutaneous left ventricular assist device (pLVAD) on renal function after high-risk PCI remains unknown., Objective: We tested the hypothesis that partial hemodynamic support with the Impella 2.5 microaxial pLVAD during high-risk PCI protected against AKI., Methods and Results: In this retrospective, single-center study, we analyzed data from 230 patients (115 consecutive pLVAD-supported and 115 unsupported matched-controls) undergoing high-risk PCI with ejection fraction ≤35%. The primary outcome was incidence of in-hospital AKI according to AKI network criteria. Logistic regression analysis determined the predictors of AKI. Overall, 5.2% (6) of pLVAD-supported patients versus 27.8% (32) of unsupported control patients developed AKI ( P <0.001). Similarly, 0.9% (1) versus 6.1% (7) required postprocedural hemodialysis ( P <0.05). Microaxial pLVAD support during high-risk PCI was independently associated with a significant reduction in AKI (adjusted odds ratio, 0.13; 95% confidence intervals, 0.09-0.31; P <0.001). Despite preexisting CKD or a lower ejection fraction, pLVAD support protection against AKI persisted (adjusted odds ratio, 0.63; 95% confidence intervals, 0.25-0.83; P =0.04 and adjusted odds ratio, 0.16; 95% confidence intervals, 0.12-0.28; P <0.001, respectively)., Conclusions: Impella 2.5 (pLVAD) support protected against AKI during high-risk PCI. This renal protective effect persisted despite the presence of underlying CKD and decreasing ejection fraction., (© 2017 American Heart Association, Inc.)
- Published
- 2017
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