Meta-Analysis of Usefulness of Percutaneous Left Ventricular Assist Devices for High-Risk Percutaneous Coronary Interventions.
High-risk percutaneous coronary intervention (PCI) is often offered to patients with extensive coronary artery disease, decreased left ventricular function, and co-morbid conditions that increase surgical risk. In these settings, percutaneous left ventricular assist devices (PVADs) can be used for hemodynamic support. To assess the effects of PVAD use on mortality, myocardial infarction, and complication rates in patients undergoing high-risk PCI, we systematically searched the electronic databases, MEDLINE, PUBMED, EMBASE, and Cochrane for prospective controlled trials and cohort studies of patients that received hemodynamic support with PVADs for high-risk PCI. The primary outcome measures were 30-day all-cause mortality, 30-day myocardial infarction rates, periprocedural major bleeding, and vascular complications. We included 12 studies with 1,346 participants who underwent Impella 2.5 L device placement and 8 cohort studies with 205 patients that received TandemHeart device for high-risk PCI. Short-term mortality rates were 3.5% and 8% and major bleeding rates were 7.1% and 3.6% with Impella and TandemHeart, respectively. Both devices are associated with comparable periprocedural outcomes in patients undergoing high-risk PCI.
Division of Cardiology, Detroit Medical Center, Wayne State University, Detroit, Michigan. Electronic address: alexbriasoulis@gmail.com.
Alexandros
A
Briasoulis
Division of Cardiology, Detroit Medical Center, Wayne State University, Detroit, Michigan.
Tesfaye
T
Telila
Division of Cardiology, Detroit Medical Center, Wayne State University, Detroit, Michigan.
Mohan
M
Palla
Division of Cardiology, Detroit Medical Center, Wayne State University, Detroit, Michigan.
Nestor
N
Mercado
Division of Cardiology, Detroit Medical Center, Wayne State University, Detroit, Michigan.
Ashok
A
Kondur
Division of Cardiology, Detroit Medical Center, Wayne State University, Detroit, Michigan.
Cindy
C
Grines
Division of Cardiology, Detroit Medical Center, Wayne State University, Detroit, Michigan.
Theodore
T
Schreiber
D001243:Assisted Circulation / Q000379:methods*; D001803:Blood Transfusion; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D009026:Mortality; D009203:Myocardial Infarction / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000628:therapy; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology / Q000628:therapy*