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. 2019 Apr 9:2019:5243913.
doi: 10.1155/2019/5243913. eCollection 2019.

Long-Term Outcomes of Extent of Revascularization in Complex High Risk and Indicated Patients Undergoing Impella-Protected Percutaneous Coronary Intervention: Report from the Roma-Verona Registry

Francesco Burzotta  1   2 , Giulio Russo  1   2 , Flavio Ribichini  3 , Anna Piccoli  3 , Domenico D'Amario  1   2 , Lazzaro Paraggio  1   2 , Leonardo Previ  1   2 , Gabriele Pesarini  3 , Italo Porto  1   2 , Antonio Maria Leone  1   2 , Giampaolo Niccoli  1   2 , Cristina Aurigemma  1   2 , Diana Verdirosi  1   2 , Filippo Crea  1   2 , Carlo Trani  1   2
Affiliations

Long-Term Outcomes of Extent of Revascularization in Complex High Risk and Indicated Patients Undergoing Impella-Protected Percutaneous Coronary Intervention: Report from the Roma-Verona Registry

Francesco Burzotta et al. J Interv Cardiol. .

Abstract

Objective: To investigate the effect of extent of revascularization in complex high-risk indicated patients (CHIP) undergoing Impella-protected percutaneous coronary intervention (PCI).

Background: Complete revascularization has been shown to be associated with improved outcomes. However, the impact of more complete revascularization during Impella-protected PCI in CHIP has not been reported.

Methods: A total of 86 CHIP undergoing elective PCI with Impella 2.5 or Impella CP between April 2007 and December 2016 from 2 high volume Italian centers were included. Baseline, procedural, and clinical outcomes data were collected retrospectively. Completeness of coronary revascularization was assessed using the British Cardiovascular Intervention Society myocardial jeopardy score (BCIS-JS) derived revascularization index (RI). The primary end-point was all-cause mortality. A multivariate regression model was used to identify independent predictors of mortality.

Results: All patients had multivessel disease and were considered unsuitable for surgery. At baseline, 44% had left main disease, 78% had LVEF ≤ 35%, and mean BCIS-JS score was 10±2. The mean BCIS-JS derived RI was 0.7±0.2 and procedural complications were uncommon. At 14-month follow-up, all-cause mortality was 10.5%. At follow-up, 67.4% of CHIP had LVEF ≥ 35% compared to 22.1% before Impella protected-PCI. Higher BCIS-JS RI was significantly associated with LVEF improvement (p=0.002). BCIS-JS RI of ≤ 0.8 (HR 0.11, 95% CI 0.01- 0.92, and p = 0.042) was an independent predictor of mortality.

Conclusions: These results support the practice of percutaneous Impella use for protected PCI in CHIP. A more complete revascularization was associated with significant LVEF improvement and survival.

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Conflict of interest statement

Dr. Burzotta discloses to have been involved in advisory board meetings or having received speaker's fees from Medtronic, St Jude Medical, Abiomed, Biotronic. Dr. Trani discloses to have been involved in advisory board meetings or having received speaker's fees from St Jude Medical, Abiomed, Biotronic. Dr. Aurigemma has been involved in advisory board activities by Biotronic. The remaining authors have nothing to disclose.

Figures

Figure 1
Figure 1
British-Cardiovascular-Intervention-Society jeopardy-score (BCIS-JS) calculation examples in a patient with complete (a) and in a patient with incomplete (b) myocardial revascularization. Patient in (a) showed a significant improvement of left ventricular function, while patient in (b) died after 6 months of follow-up. Arrows indicate significant coronary stenosis. PCI=percutaneous coronary intervention and LVEF=left ventricular ejection fraction.
Figure 2
Figure 2
Left ventricular ejection fraction improvement during the follow-up after IMP-protected PCI. The figure shows the comparison of left ventricular ejection fraction impairment between pre-PCI and follow-up assessment. LVEF=left ventricular ejection fraction and PCI=percutaneous coronary intervention.
Figure 3
Figure 3
Left ventricular ejection fraction improvement according to revascularization extent. The figure shows the left ventricular improvement in patients stratified according to revascularization extent as evaluated by the British Cardiovascular Intervention Society Jeopardy Score (BCIS-JS) tertiles. LVEF=left ventricular ejection fraction.
Figure 4
Figure 4
Survival curves according to revascularization extent. The figure shows the adjusted survival curves in the study population stratified according to British Cardiovascular Intervention Society Jeopardy Score (BCIS-JS) revascularization index tertiles. RI= revascularization index.
See this image and copyright information in PMC

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