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High-Risk PCI
High-Risk PCI
Patients with poor LV function undergoing high-risk PCI may develop hypotension and decreased cardiac output leading to hemodynamic collapse. Accordingly, prophylactic stabilization is often employed in these high-risk patients to prevent hemodynamic instability and adverse peri-procedural outcomes.1
Elective IABP in high-risk PCI:
- Protects the myocardium
- Prevents intra-procedural MACCE2
- Improves in-hospital and 6-month mortality3
ELECTIVE IABP REDUCES PROCEDURAL COMPLICATIONS
ELECTIVE IABP REDUCES PROCEDURAL MACCE
ELECTIVE IABP IMPROVES 6 MONTH OUTCOMES
1 A Prospective Feasibility Trial Investigating the Impella 2.5 System in Patients Undergoing High-Risk PCI. S R Dixon JACC 2009;2:91-6
2 Elective versus provisional IABP in high-risk PCI. C Briguori, et al. AHJ 2003;145:700-7
3 Role of prophylactic IABP in high-risk patients undergoing PCI. S Mishra, et al. Am J Cardiol 2006;98:608-612
Improvement in Hemodynamics with a New Larger Volume 50cc IAB for High Risk PCI Study
(PDF: 94KB / 2 Pages)
(PDF: 4.3MB / 5 Pages)
Pradeep K. Nair, MD, Sun Scolieri, MD, Ashley B. Lee, MD
Abstract: A primary cause of adverse outcomes among high-risk patients undergoing percutaneous coronary intervention (PCI) may be a diminished capacity to tolerate the hemodynamic and ischemic insults that can occur during the procedure. A common means of mechanical support during PCI has been the intra-aortic balloon pump (IABP). We describe successful periprocedural mechanical support with a new, 50cc IABP in a patient with both severe left ventricular dysfunction and extensive coronary arteriosclerosis, for whom PCI with stenting was indicated. The prophylactic use of this 50cc IABP, which traditionally would be contraindicated because of the patient’s height (162.6 cm), markedly increased the diastolic aortic pressure (by ~110 mmHg) over the baseline level, while promptly reducing left-sided heart pressures. This finding appears to exceed the average diastolic augmentation reported for smaller-volume balloons. Although the role of the IABP in high-risk PCI remains controversial, further research is warranted to clarify and compare this new 50cc IABP to smaller-volume balloons, and ascertain whether the observed hemodynamic benefits can translate into improved clinical outcomes among patients requiring mechanical support during PCI.
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