Percutaneous ventricular assist device for higher-risk percutaneous coronary intervention in surgically ineligible patients: Indications and outcomes from the OPTIMUM study

Taishi Hirai, J. Aaron Grantham, David E. Kandzari, William Ballard, W. Morris Brown, Keith B. Allen, Ajay J. Kirtane, Michael Argenziano, Robert W. Yeh, Kamal Khabbaz, William Lombardi, John Lasala, Puja Kachroo, Dimitri Karmpaliotis, Kensey L. Gosch, Adam C. Salisbury

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Indications and outcomes for percutaneous ventricular assist device (pVAD) use in surgically ineligible patients undergoing percutaneous coronary intervention (PCI) remain poorly characterized. Aims: We sought to describe the use and timing of pVAD and outcome in surgically ineligible patients. Methods: Among 726 patients enrolled in the prospective OPTIMUM study, clinical and health status outcomes were assessed in patients who underwent pVAD-assisted PCI and those without pVAD. Results: Compared with patients not receiving pVAD (N = 579), those treated with pVAD (N = 142) more likely had heart failure, lower left ventricular ejection fraction (30.7 ± 13.6 vs. 45.9 ± 15.5, p < 0.01), and higher STS 30-day predicted mortality (4.2 [2.1−8.0] vs. 3.3 [1.7−6.6], p = 0.01) and SYNTAX scores (36.1 ± 12.2, vs. 31.5 ± 12.1, p < 0.01). While the pVAD group had higher in-hospital (5.6% vs. 2.2%, p = 0.046), 30-day (9.0% vs. 4.0%, p = 0.01) and 6-month (20.4% vs. 11.7%, p < 0.01) mortality compared to patients without pVAD, this difference appeared to be largely driven by significantly higher mortality among the 20 (14%) patients with unplanned pVAD use (30% in-hospital mortality with unplanned PVAD vs. 1.6% with planned, p < 0.01; 30-day mortality, 38.1% vs. 4.5%, p < 0.01). The degree of 6-month health status improvement among survivors was similar between groups. Conclusion: Surgically ineligible patients with pVAD-assisted PCI had more complex baseline characteristics compared with those without pVAD. Higher mortality in the pVAD group appeared to be driven by very poor outcomes by patients with unplanned, rescue pVAD.

Original languageEnglish
Pages (from-to)814-822
Number of pages9
JournalCatheterization and Cardiovascular Interventions
Volume102
Issue number5
DOIs
StatePublished - Nov 1 2023

Keywords

  • high-risk percutaneous coronary intervention
  • percutaneous ventricular assist device
  • quality of life
  • surgical ineligible

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