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.

急性肾损伤（AKI）是 PCI 术后常见的并发症。在这里，在单中心观察登记中，我们比较了接受 VA-ECMO 或 Impella 支持的高风险 PCI 的 AKI 风险较高的患者（基于 Mehran 风险分层评分）的 AKI 频率。共有 28 名计划接受机械循环支持的择期高危 PCI 患者进行了前瞻性研究。由于风险极高，所有患者都被拒绝接受手术。分配给 VA-ECMO (n=11) 或 Impella (n=17) 是根据 VA-ECMO 平台每日可用性的具体限制进行的，作为前瞻性入组，并在 PCI 开始之前进行。我们分析了 AKI 发生率作为我们的主要终点，以及 PCI 成功率、持续时间和外周并发症。所有患者均成功进行血运重建，并在手术结束时撤消 MCS。基线 GFR 和程序造影剂相似。尽管根据 Mehran 评分计算，AKI 风险相似（35 ± 18.9 与 31 ± 16.6 %；p=0.55），但 PCI 期间接受 Impella 支持的患者表现出 AKI 发生率降低（55 与 12 %；p=0.03） 。采用 VA-ECMO 或 Impella 进行 MCS 辅助高风险 PCI 是可行的。然而，Impella 的手术时间较短且 AKI 发生率较低。