title: High-risk PCI in acute coronary syndromes with Impella LP 2.5 device support.
abstract: OBJECTIVE
  To evaluate feasibility, safety, efficacy as well as acute and short-term outcome of hemodynamically supported percutaneous coronary intervention (PCI) by a percutaneous, catheter-based left ventricular assist device (LVAD) (Impella LP 2.5, Abiomed Europe GmbH, Aachen, Germany) in a high-risk patient population with acute coronary syndrome.
  
  
  BACKGROUND
  Although hemodynamic support by intraaortic balloon pump favorably affects myocardial oxygen supply and demand, it has modest effects on cardiac output, providing passive support only. In contrast, the Impella LP 2.5 microaxial pump, which is placed within the left ventricular outflow tract and actively ejects blood into the ascending aorta, might offer additional hemodynamic support and thereby procedural safety during PCI.
  
  
  METHODS
  Thirty-eight consecutive high-risk patients (mean age, 69.7 ± 10.3 years, logistic EuroSCORE, 22.4 ± 14.9%) with unstable angina pectoris or non-ST-segment elevation myocardial infarction and severe three-vessel-disease were included in the study. Clinical and laboratory examinations were performed at baseline as well as at 6, 24 and 48 h after the procedure and 30 days after discharge.
  
  
  RESULTS
  Device insertion and explantation was feasible in all patients without vascular complications and continuous hemodynamic stability was obtained during PCI. PCI was uneventfully performed in all but one patient for technical reasons. One non procedure-related death occurred 7 days after the intervention, accounting for a total 30-day mortality of 2.86%. Other major cardiac or cerebrovascular events did not occur.
  
  
  CONCLUSIONS
  LVAD support using a percutaneous microaxial flow pump is a promising and safe approach for high-risk PCI providing good short-term results.
authors.affiliation: Department of Cardiology, West German Heart Center Essen, University Duisburg-Essen, Hufelandstr. 55, D-45122 Essen, Germany. k.iliodromitis@gmail.com
authors.forename: Konstantinos E
authors.initials: KE
authors.lastname: Iliodromitis
authors.forename: Philipp
authors.initials: P
authors.lastname: Kahlert
authors.forename: Bjorn
authors.initials: B
authors.lastname: Plicht
authors.forename: Andreas-Claudius
authors.initials: AC
authors.lastname: Hoffmann
authors.forename: Holger
authors.initials: H
authors.lastname: Eggebrecht
authors.forename: Raimund
authors.initials: R
authors.lastname: Erbel
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Konorza
mesh_terms: D054058:Acute Coronary Syndrome / Q000503:physiopathology / Q000628:therapy*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology