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Improved outcomes in patients with severely depressed LVEF undergoing percutaneous coronary intervention with contemporary practices

Authors :
William W, O'Neill
Mark, Anderson
Daniel, Burkhoff
Cindy L, Grines
Navin K, Kapur
Alexandra J, Lansky
Salvatore, Mannino
James M, McCabe
Khaldoon, Alaswad
Ramesh, Daggubati
David, Wohns
Perwaiz M, Meraj
Duane S, Pinto
Jeffrey J, Popma
Jeffrey W, Moses
Theodore L, Schreiber
E, Magnus Ohman
Source :
American Heart Journal. 248:139-149
Publication Year :
2022
Publisher :
Elsevier BV, 2022.

Abstract

Contemporary practices for hemodynamically supported high-risk percutaneous coronary intervention have evolved over the last decade. This study sought to compare outcomes of the prospective, multicenter, PROTECT III study to historic patients treated with Impella in the PROTECT II randomized controlled trial.Of 1,134 patients enrolled in PROTECT III from March 2017 to March 2020, 504 were "PROTECT II-like" (met eligibility for PROTECT II randomized controlled trial) and are referred to as PROTECT III for comparative analysis. Major adverse cardiac and cerebrovascular events (MACCE), comprising all-cause mortality, stroke/transient ischemic attack, myocardial infarction, and repeat revascularization, were compared at hospital discharge and 90 days.Compared with PROTECT II (N = 216), PROTECT III patients were less often Caucasian (77.1% vs 83.8%, P = .045), with less prior CABG (13.7% vs 39.4%; P.001) and prior myocardial infarction (40.7% vs 69.3%; P.001). More PROTECT III patients underwent rotational atherectomy (37.1% vs 14.8%, P.001) and duration of support was longer (median 1.6 vs 1.3 hours; p0.001), with greater improvement achieved in myocardial ischemia jeopardy scores (7.0±2.4 vs 4.4±2.9; P.001) and SYNTAX scores (21.4±10.8 vs 15.7±9.5; P.001). In-hospital bleeding requiring transfusion was significantly lower in PROTECT III (1.8% vs 9.3%; P.001), as was procedural hypotension (2.2% vs 10.1%; P.001) and cardiopulmonary resuscitation or ventricular arrhythmia (1.6% vs 6.9%; P.001). At 90 days, MACCE was 15.1% and 21.9% in PROTECT III and PROTECT II, respectively (p=0.037). Following propensity score matching, Kaplan-Meier analysis showed improved 90-day MACCE rates in PROTECT III (10.4% vs 16.9%, P = .048).The PROTECT III study demonstrates improved completeness of revascularization, less bleeding, and improved 90-day clinical outcomes compared to PROTECT II for Impella-supported high-risk percutaneous coronary intervention among patients with severely depressed LVEF.

Details

ISSN :
00028703
Volume :
248
Database :
OpenAIRE
Journal :
American Heart Journal
Accession number :
edsair.doi.dedup.....3eeb0d23a58e4ba1a44e72535e37bd2a
Full Text :
https://doi.org/10.1016/j.ahj.2022.02.006