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Prophylactic Mechanical Circulatory Support Use in Elective Percutaneous Coronary Intervention for Patients With Stable Coronary Artery Disease
Circulation: Cardiovascular Interventions ( IF 5.6 ) Pub Date : 2022-05-17 , DOI: 10.1161/circinterventions.121.011534
Michel Zeitouni 1 , Guillaume Marquis-Gravel 1 , Nathaniel R Smilowitz 2 , Pearl Zakroysky 1 , Daniel M Wojdyla 1 , Amin P Amit 3 , Sunil V Rao 1 , Tracy Y Wang 1
Affiliation  

Background:Mechanical circulatory support (MCS) devices can be used in high-risk percutaneous coronary intervention (PCI). Our objective was to describe trends and outcomes of prophylactic MCS use in elective PCI for patients with stable coronary artery disease in the American College of Cardiology National Cardiovascular Data Registry’s CathPCI registry.Methods:Among 2 108 715 consecutive patients with stable coronary artery disease undergoing elective PCI in the CathPCI registry between 2009 and 2018, we examined patterns of prophylactic use of MCS. Propensity score models with inverse probability of treatment weighting compared effectiveness (in-hospital death, cardiogenic shock, or new heart failure) and safety (stroke, tamponade, major bleeding, or vascular complication requiring treatment) between patients treated with intra-aortic balloon pump versus other MCS (Impella or extracorporeal membrane oxygenation).Results:Overall, 6905 (0.3%) patients underwent elective PCI with prophylactic MCS. MCS use trended up from 0.2% of elective PCIs in 2009 to 0.6% in 2018 (P<0.0001), driven by other MCS (P<0.0001), whereas intra-aortic balloon pump use remained low and constant (P=0.12). In-hospital major adverse cardiac events and cardiovascular complications occurred in 7.1% and 18.8% of elective PCI patients with prophylactic MCS use and 0.5% and 2.3% of patients without prophylactic MCS use. Intra-aortic balloon pump use was associated with a higher risk of major adverse cardiac events (9.6% versus 6.0%, adjusted odds ratio, 1.59 [95% CI, 1.32–1.91]) but lower risk of complications (18.2% versus 19.1%, adjusted odds ratio, 0.88 [95% CI, 0.77–0.99]) than use of other MCS.Conclusions:The use of prophylactic MCS has increased over time for elective PCI in patients with stable coronary artery disease. Intra-aortic balloon pump was associated with higher major adverse cardiac events but lower risk of procedural complications compared with other MCS.

中文翻译:

预防性机械循环支持在稳定冠状动脉疾病患者选择性经皮冠状动脉介入治疗中的应用

背景:机械循环支持(MCS)装置可用于高危经皮冠状动脉介入治疗(PCI)。我们的目标是在美国心脏病学会国家心血管数据登记处的 CathPCI 登记处描述在选择性 PCI 中对稳定型冠状动脉疾病患者进行预防性 MCS 的趋势和结果。方法:在 2 108 715 名连续接受选择性 PCI 的稳定型冠状动脉疾病患者中我们在 2009 年至 2018 年间的 CathPCI 注册中心中检查了 MCS 的预防性使用模式。具有治疗加权逆概率的倾向评分模型比较有效性(院内死亡、心源性休克或新发心力衰竭)和安全性(中风、填塞、大出血、主动脉内球囊泵与其他 MCS(Impella 或体外膜氧合)治疗的患者之间的差异。结果:总体而言,6905 名 (0.3%) 患者接受了预防性 MCS 的选择性 PCI。MCS 的使用率从 2009 年的 0.2% 上升到 2018 年的 0.6%(P <0.0001),由其他 MCS 驱动(P <0.0001),而主动脉内球囊泵的使用率保持较低且恒定(P=0.12)。院内主要不良心脏事件和心血管并发症发生在 7.1% 和 18.8% 的选择性 PCI 患者中,预防性 MCS 使用,0.5% 和 2.3% 的患者未预防性 MCS 使用。使用主动脉内球囊泵与较高的主要不良心脏事件风险相关(9.6% vs 6.0%,调整后的比值比,1.59 [95% CI,1.32-1.91])但并发症风险较低(18.2% vs 19.1% , 调整后的优势比, 0.88 [95% CI, 0.77–0.99]) 比使用其他 MCS。结论:对于稳定型冠状动脉疾病患者的选择性 PCI,预防性 MCS 的使用随着时间的推移而增加。与其他 MCS 相比,主动脉内球囊泵与较高的主要不良心脏事件相关,但手术并发症的风险较低。
更新日期:2022-05-18
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