title: Use of the Impella 2.5 for prophylactic circulatory support during elective high-risk percutaneous coronary intervention.
abstract: BACKGROUND
  Patients undergoing percutaneous coronary intervention (PCI) who are at high risk for cardiovascular collapse during the procedure may benefit from prophylactic circulatory support. The objective was to evaluate the safety and feasibility of prophylactic use of the Impella 2.5 during high-risk PCI.
  
  
  METHODS
  We used the Impella 2.5 for partial circulatory support during 60 consecutive elective high-risk PCI cases over 20 months. All patients either were deemed inoperable by the cardiac surgeons or were offered bypass surgery but declined.
  
  
  RESULTS
  The patients had multiple risk factors including hypertension (95%), diabetes (52%), chronic pulmonary disease (23%), prior myocardial infarction (62%) and prior bypass surgery (18%). Forty-five percent presented with acute coronary syndrome. The mean left ventricular ejection fraction was 23%±15%. Nearly all patients had multivessel disease (93%), and 60% had left main disease. The average SYNTAX score was 30±9. Despite lesion complexity and high-risk factors, we achieved an angiographic success rate of 96%. Left main lesions were treated in 55% of the patients, and 83% of patients had multiple lesions treated. There was one procedural death. At 30 days postintervention, mortality was 5%, and rates of myocardial infarction, stroke, target vessel revascularization and urgent bypass surgery were 0%.
  
  
  CONCLUSIONS
  The single-center experience reported here demonstrates that use of the Impella 2.5 during high-risk PCI in the "real world" - outside the controlled environment of a clinical trial - is safe and feasible.
authors: Harper University Hospital, Detroit Medical Center, Detroit, MI, USA. mirvat@jeddacath.com
authors: Mirvat A
authors: MA
authors: Alasnag
authors: Delair O
authors: DO
authors: Gardi
authors: Mahir
authors: M
authors: Elder
authors: Hari
authors: H
authors: Kannam
authors: Farhan
authors: F
authors: Ali
authors: Mircea
authors: M
authors: Petrina
authors: Vipin
authors: V
authors: Kheterpal
authors: Mariah S
authors: MS
authors: Hout
authors: Theodore L
authors: TL
authors: Schreiber
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000401:mortality; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D006353:Heart-Assist Devices / Q000009:adverse effects; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008824:Michigan; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012769:Shock / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome