title: Comparison of Impella and intra-aortic balloon pump in high-risk percutaneous coronary intervention: vascular complications and incidence of bleeding.
abstract: OBJECTIVE
  Compare vascular complications and incidence of bleeding of Impella 2.5 and intra-aortic balloon pump (IABP) in high-risk percutaneous coronary interventions (PCI).
  
  
  BACKGROUND
  Large arterial sheath size for device insertion is associated with vascular and/or bleeding complications; gastrointestinal bleeding may also occur with anti-coagulation use.
  
  
  METHODS
  Patients with an acute coronary syndrome receiving Impella 2.5 or IABP during high-risk PCI were studied (13 Impella; 62 IABP). Vascular complications and incidence of bleeding were compared.
  
  
  RESULTS
  Post-procedure hematocrit was similar between groups. Blood transfusion occurred in 38.4% and 32.2% of patients in the Impella and IABP groups, respectively (P = NS); 65.3%, 30.7% and 3.8% of bleeding were due to vascular access site/procedure related, gastrointestinal and genitourinary, respectively. There was no statistical significant difference in vascular complications between the Impella and IABP groups (15.3% and 6.4% of patients, respectively); mesenteric ischemia (n = 1) and aortic rupture (n = 1) were only in the IABP group. In-hospital and one-year mortality were not statistically significant between groups.
  
  
  CONCLUSIONS
  Impella can be used as safely as IABP during high-risk PCI with similar vascular and bleeding complications. Importantly, approximately one third of bleeding was from the gastrointestinal system warranting careful prophylactic measures and monitoring.
authors.affiliation: Division of Cardiovascular Medicine, Section of Interventional Cardiology, The Ohio State University, Columbus, Ohio 43210, USA. kdboudoulas@osumc.edu
authors.forename: Konstantinos Dean
authors.initials: KD
authors.lastname: Boudoulas
authors.forename: Andrew
authors.initials: A
authors.lastname: Pederzolli
authors.forename: Uksha
authors.initials: U
authors.lastname: Saini
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Gumina
authors.forename: Ernest L
authors.initials: EL
authors.lastname: Mazzaferri
authors.forename: Michael
authors.initials: M
authors.lastname: Davis
authors.forename: Charles A
authors.initials: CA
authors.lastname: Bush
authors.forename: Quinn
authors.initials: Q
authors.lastname: Capers
authors.forename: Raymond
authors.initials: R
authors.lastname: Magorien
authors.forename: Vincent J
authors.initials: VJ
authors.lastname: Pompili
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality / Q000628:therapy*; D000368:Aged; D001803:Blood Transfusion / Q000706:statistics & numerical data; D023921:Coronary Stenosis; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006400:Hematocrit; D006439:Hemodynamics; D006470:Hemorrhage / Q000209:etiology*; D017052:Hospital Mortality; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies