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Review
. 2025 Nov 8:S1553-8389(25)00568-8.
doi: 10.1016/j.carrev.2025.10.019. Online ahead of print.

Percutaneous micro-axial flow pump use during non-emergent high-risk PCI: Systematic review and meta-analysis

Hossam Elbenawi  1 , Mohamed Doma  2 , Busra Cangut  3 , Mahmoud Shaaban Abdelgalil  4 , Yehya Khlidj  5 , Priyesh Thakurathi  6 , Amer Hammad  7 , Fathia Mohammed  7 , Omar Almaadawy  8 , Hassan Farhoud  9 , Ramy Ghaly  10 , Ubaid Khan  11 , Islam Abdelkarim  12 , Morad Zaaya  13 , Ramzi Ibrahim  14 , Obadah Aqtash  15 , Yasser Ahmed Sadek  16 , Karim M Al-Azizi  17 , Chien-Jung Lin  18 , Andrew M Goldsweig  19 , Ayman Elbadawi  20 , Gregg W Stone  21 , Islam Y Elgendy  22
Affiliations
Review

Percutaneous micro-axial flow pump use during non-emergent high-risk PCI: Systematic review and meta-analysis

Hossam Elbenawi et al. Cardiovasc Revasc Med. .

Abstract

Background: Percutaneous micro-axial flow pumps (mAFP) are increasingly used for hemodynamic support during high-risk percutaneous coronary interventions (PCI) despite limited evidence supporting their effectiveness. We conducted a meta-analysis to assess the effectiveness and safety of mAFP use during non-emergent high-risk PCI procedures.

Methods: Electronic databases were searched for studies comparing percutaneous mAFP versus control for non-emergent high-risk PCI. The primary outcome was the incidence of major adverse cardiac events (MACE).

Results: Eight studies (one randomized, seven observational) with 4688 patients were included. There were no significant differences in the risk of MACE within 30 days (RR 1.34; 95 % CI 0.73-2.47) or at 1 year (RR 1.08; 95 % CI 0.58-1.98) in patients treated with vs. without a mAFP during high-risk PCI. Nor was the risk of mortality different between groups. Peri-procedural complications, including acute kidney injury, major bleeding, blood transfusions, myocardial infarction, and stroke, were not increased with the mAFP. The subgroup of patients who received mAFP prior to PCI again had similar risk of MACE and mortality compared with the control. However, in this group, mAFP use was associated with higher in-hospital risks of major bleeding (RR 2.77; 95 % CI 1.28-5.98) and blood transfusion (RR 2.20; 95 % CI 1.17-4.15) and of in-hospital or 30-day myocardial infarction (RR 1.68; 95 % CI 1.03-2.73).

Conclusions: mAFP use was not associated with improved outcomes among patients undergoing non-emergent high-risk PCI. Given the potential for selection bias, ongoing large-scale randomized trials are necessary to determine its impact on efficacy and safety.

Social media abstract: In 4688 patients undergoing non-emergent high-risk PCI, use of a percutaneous micro-axial flow pump did not reduce MACE or mortality at 30 days or 6 months, and pre-PCI use was linked to higher risks of bleeding and in-hospital MI, warranting further large-scale trials.

Keywords: Impella; Mechanical circulatory support; Meta-analysis; Micro-axial flow pumps; Percutaneous coronary intervention.

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Conflict of interest statement

Declaration of competing interest Dr. Goldsweig reports speaking on behalf of Philips and Boston Scientific, and consulting for Abbott, Occlutech, and Conformal Medical. Dr. Stone has received speaker honoraria from Medtronic, Amgen, Boehringer Ingelheim; has served as a consultant to Robocath, Daiichi Sankyo, Vectorious, Miracor, Apollo Therapeutics, Cardiac Success, Occlutech, Millennia Biopharma, Ablative Solutions, Oxitope, Elixir, Impulse Dynamics, Asceneuron, Myochron, Remote Cardiac Enablement, Valfix, Zoll, HeartFlow, Shockwave, Adona Medical, Abbott, HighLife, Elucid Bio, Aria, Alleviant, FBR Medical, Colibri, Bioventrix, MedHub; and has equity/options from Cardiac Success, Ancora, Cagent, Applied Therapeutics, Biostar family of funds, SpectraWave, Orchestra Biomed, Aria, Valfix, Xenter. Dr. Stone's employer, Mount Sinai Hospital, receives research grants from Shockwave, Biosense-Webster, Bioventrix, Abbott, Abiomed, Cardiovascular Systems Inc., Phillips, Pulnovo, V-wave, and PCORI (via Weill Cornell Medical Center). No other authors report relationships with industry to declare.

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