Mechanical circulatory support devices for elective percutaneous coronary interventions: novel insights from the Japanese nationwide J-PCI registry

Takashi Muramatsu; Taku Inohara; Shun Kohsaka; Kyohei Yamaji; Hideki Ishii; Toshiro Shinke; Takuo Toriya; Yu Yoshiki; Yukio Ozaki; Hirohiko Ando; Tetsuya Amano; Masato Nakamura; Yuji Ikari

doi:10.1093/ehjopen/oeac041

Mechanical circulatory support devices for elective percutaneous coronary interventions: novel insights from the Japanese nationwide J-PCI registry

Eur Heart J Open. 2022 Jun 27;2(4):oeac041. doi: 10.1093/ehjopen/oeac041. eCollection 2022 Jul.

Authors

Takashi Muramatsu¹, Taku Inohara², Shun Kohsaka², Kyohei Yamaji³, Hideki Ishii⁴, Toshiro Shinke⁵, Takuo Toriya¹, Yu Yoshiki⁶, Yukio Ozaki⁶, Hirohiko Ando⁷, Tetsuya Amano⁷, Masato Nakamura⁸, Yuji Ikari⁹

Affiliations

¹ Department of Cardiology, Cardiovascular Center, Fujita Health University Hospital, Toyoake, Japan.
² Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
³ Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan.
⁴ Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan.
⁵ Department of Cardiology, Showa University School of Medicine, Tokyo, Japan.
⁶ Department of Cardiology, Fujita Health University Okazaki Medical Center, Okazaki, Japan.
⁷ Department of Cardiology, Aichi Medical University, Nagakute, Japan.
⁸ Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan.
⁹ Department of Cardiology, Tokai University School of Medicine, Isehara, Japan.

Abstract

Aims: We examined in-hospital outcomes of patients that required mechanical circulatory support (MCS), such as intra-aortic balloon pumping (IABP), Impella®, or veno-arterial extracorporeal membrane oxygenation (VA-ECMO), for elective percutaneous coronary interventions (PCIs).

Methods and results: The J-PCI is a prospective Japanese nationwide multicentre registry sponsored by the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) and designed to collect clinical variables and in-hospital outcome data on consecutive patients undergoing PCI. Of the 253 228 patients registered between January 2018 and December 2018, 1627 patients (0.6%) undergoing elective PCI under MCS at 551 sites were analyzed. The mean age of the patients was 74 years, and 25.2% of the patients were females. Multivessel disease and left main disease were observed in 59.0% and 19.7% of the patients, respectively. Majority of patients were treated with IABP alone (86.2%), followed by IABP plus VA-ECMO (6.0%) and Impella alone (3.9%). In-hospital mortality was reported in 134 patients (8.2%). Cardiac death was more common than non-cardiac death (6.8% vs. 1.5%). About 34.6% of the patients receiving VA-ECMO died during hospitalization, whereas 7.2% and 5.3% of patients receiving Impella and IABP died, respectively (P < 0.01). The proportion of patients with VA-ECMO or Impella who had major bleeding requiring blood transfusion was higher than that of patients with IABP (14.1% vs. 13.0% vs. 2.8%).

Conclusion: In the setting of elective PCI, in-hospital mortality of patients requiring MCS was considerably high. VA-ECMO or Impella was associated with a higher risk of major bleeding than IABP.

Keywords: Cardiogenic shock; Complication; Coronary artery disease; Heart failure; Mechanical circulatory support; Percutaneous coronary intervention.