Short-Term Outcomes of Impella-Supported High-Risk Percutaneous Coronary Intervention in Surgically Ineligible Patients: Insights From PROTECT III
Year: 2025
Type: article
Abstract: Background Impella-supported high-risk percutaneous coronary intervention (HRPCI) is an alternative for patients ineligible for coronary artery bypass grafting (CABG). However, limited data exist on patient characteristics, reasons for surgical turndown, and patient outcomes. This study aimed to characterize the baseline characteristics and short-term and intermediate-term outcomes of patients evaluated for CABG in the PROTECT III study. Methods Patients enrolled in the PROTECT III study (NCT04136392), who underwent Impella-supported HRPCI, with an evaluable chart who were assessed by a cardiothoracic surgeon (CTS) for CABG were studied. Reasons for surgical turndown were derived from medical records. Baseline characteristics and major adverse cardiovascular and cerebrovascular events (composite of all-cause death, myocardial infarction, stroke/transient ischemic attack, and repeat revascularization) at 30 and 90 days and all-cause mortality at 1 year were assessed. Observed to expected 30-day mortality ratios were calculated using the Society of Thoracic Surgeons (STS) risk score. Results Of 791 patients evaluated for CABG, 680 (86.0%) were turned down by a CTS, and 111 (14.0%) declined surgery. The most common reasons for surgical turndown were comorbidities (40%) and anatomical factors (25%). Compared with patients who declined surgery, patients turned down (deemed ineligible) by CTS had higher rates of major adverse cardiovascular and cerebrovascular event at 30 days (9.2% vs 4.6%; P = .12) and 90 days (14.1% vs 4.6%; P = .02). The observed to expected mortality ratio, based on the STS risk score, was 1.43 (95% CI, 1.08-1.83). Conclusions Impella-supported HRPCI is a viable alternative for high-risk patients deemed ineligible for CABG. Patients turned down by a CTS had worse clinical outcomes than those who declined surgery. The underestimation of 30-day mortality by the STS risk score suggests the need for improved risk prediction models in this high-risk cohort.
Authors: Batla Falah, Behnam N. Tehrani, Julia B. Thompson, Yousuf Shah, Yiran Zhang, Tayyab Shah, Michael J. Schonning, Arsalan Abu-Much, David J. Cohen, Björn Redfors, Deepak Acharya, Samer M. Garas, Suzanne J. Baron, Mir B. Basir, Aditya S. Bharadwaj, Cindy L. Grines, Alejandro Lemor, Alexander G. Truesdell, William W. O’Neill, Wayne B. Batchelor
Institutions: Cardiovascular Research Foundation, Inova Health System, Inova Fairfax Hospital, University of Rochester Medicine, University of Rochester, Yale University, University of Pennsylvania Health System, University of Pennsylvania, St. Francis Hospital, Sahlgrenska University Hospital, Weill Cornell Medicine, University of Gothenburg, University of Arizona, Ascension, Massachusetts General Hospital, Baim Institute for Clinical Research, Henry Ford Health, Henry Ford Hospital, Loma Linda University Medical Center, Northside Hospital, University of Mississippi Medical Center
Language: English
Subfield: Biomedical Engineering
Field: Engineering
Domain: Physical Sciences
Open Access status: gold
Estimated APC paid: $2,400
Funder: Abiomed
OpenAlex ID: W4413662145