Incidence of Acute Kidney Injury Is Lower in High-Risk Patients Undergoing Percutaneous Coronary Intervention Supported with Impella Compared to ECMO

Abstract

Acute kidney injury (AKI) is a common complication post-PCI. Here, in a single-center observational registry, we compared the frequency of AKI in patients at elevated risk for AKI (based on Mehran risk stratification scoring) who underwent VA-ECMO- or Impella-supported high-risk PCI. A total of 28 patients scheduled for elective high-risk PCI with mechanical circulatory support were studied prospectively. All patients were turned down for surgery due to exceedingly high risk. Allocation to VA-ECMO (n=11) or Impella (n=17) was performed according to site-specific restrictions on the daily availability of the VA-ECMO platform as a prospective enrollment and performed prior to initiation of PCI. We analyzed AKI incidence as our primary endpoint, as well as PCI success, duration, and peripheral complications. All patients were successfully revascularized and had MCS weaned at the end of the procedure. Baseline GFR and procedural contrast media were similar. Despite similar risks for AKI as calculated by the Mehran score (35 ± 18.9 vs. 31 ± 16.6 %; p=0.55), patients supported by Impella during PCI demonstrated a reduced incidence of AKI (55 vs. 12 %; p=0.03). MCS-assisted high-risk PCI with VA-ECMO or Impella is feasible. However, Impella is associated with a shorter procedure time and a lower incidence of AKI.

Keywords: Acute kidney injury; High-risk PCI; Impella; Mechanical circulatory support; VA-ECMO.

Fig. 1

Procedural characteristics. The procedural time was shorter in the Impella cohort

Fig. 2

Serial serum creatinine measurements following coronary revascularization. SCr significantly increased in the VA-ECMO cohort compared to the Impella cohort at days 1–3 post-procedure. Numbers within the columns indicate the number of patients with creatinine measurements at each time point. The decrease in the number of patients at days 3 and 4 reflects the number of stable patients in which SCr measurements were no longer required

Fig. 3

Impella patients developed less AKI despite a similar risk. a Right: the predicted rate of developing AKI in each cohort as calculated using the Mehran risk score (VA-ECMO = 35±19, Impella = 31±17%). Left: the actual observed rate of AKI (VA-ECMO = 54%; Impella = 12%). b The predicted rate of developing AKI using the Mehran risk score in subpopulations of patients who developed AKI (left, VA-ECMO=38±22%, Impella=42±22%, n.s.) and those who did not develop AKI (right, VA-ECMO=35±13%, Impella=28±18%, n.s.). These data indicate that that baseline risk developing AKI was similar in these patient subpopulations. c The rate of developing AKI 1 or AKI 2–3 was not different amongst the cohorts

Fig. 4

The rate of AKI is independent of baseline GFR and amount of contrast media used. a Baseline GFR did not differ when comparing entire cohorts (left), patients who did not develop AKI (middle), and patients who developed AKI (right). b The amount of contrast media used did not differ when comparing entire cohorts (left) or those patients who developed AKI (left). Impella patients who did not develop AKI received significantly less CM compared to patients supported with VA-ECMO who also did not develop AKI (middle). (n=11 VA-ECMO, 17 Impella, *p<0.05)