Impact of in-Hospital Left Ventricular Ejection Fraction Recovery on Long-Term Outcomes in Patients Who Underwent Impella Support for HR PCI or Cardiogenic Shock: A Sub-Analysis from the IMP-IT Registry

Author:

Iannaccone Mario1ORCID,Franchin Luca1,Burzotta Francesco2ORCID,Botti Giulia3ORCID,Pazzanese Vittorio4,Briguori Carlo5,Trani Carlo2,Piva Tommaso6ORCID,De Marco Federico7,Masiero Giulia8,Di Biasi Maurizio9,Pagnotta Paolo10,Casu Gavino11,Scandroglio Anna Mara12,Tarantini Giuseppe8,Chieffo Alaide3

Affiliation:

1. Department of Cardiology, San Giovanni Bosco Hospital, 10100 Turin, Italy

2. Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00100 Rome, Italy

3. Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 20100 Milan, Italy

4. Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, 20100 Milan, Italy

5. Interventional Cardiology Unit, Mediterranea Cardiocentro, 80100 Naples, Italy

6. Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy

7. Valvular and Structural Heart Cardiology, Centro Cardiologico Monzino, 20100 Milan, Italy

8. Department of Cardiac, Thoracic and Vascular Science, University of Padua, 35100 Padua, Italy

9. Interventional Cardiology Unit, Ospedale Luigi Sacco, 20100 Milan, Italy

10. Cardiovascular Department, Humanitas Research Hospital, 20089 Rozzano, Italy

11. Clinical and Interventional Cardiology, Sassari University Hospital, 07100 Sassari, Italy

12. Advanced Heart Failure and Mechanical Circulatory Support Program, San Raffaele Scientific Institute, Vita Salute University, 20100 Milan, Italy

Abstract

(1) Background: Percutaneous left ventricle assist devices (pLVADs) demonstrated an improvement in mid-term clinical outcomes in selected patients with severely depressed left ventricular ejection fraction (LVEF) undergoing percutaneous coronary interventions. However, the prognostic impact of in-hospital LVEF recovery is unclear. Accordingly, the present sub-analysis aims to evaluate the impact of LVEF recovery in both cardiogenic shock (CS) and high-risk percutaneous coronary intervention (HR PCI) supported with pLVADs in the IMP-IT registry. (2) Methods: A total of 279 patients (116 patients in CS and 163 patients in HR PCI) treated with Impella 2.5 or CP in the IMP-IT registry were included in this analysis, after excluding those who died while in the hospital or with missing data on LVEF recovery. The primary study objective was a composite of all-cause death, rehospitalisation for heart failure, left ventricle assist device (LVAD) implantation, or heart transplantation (HT), overall referred to as the major adverse cardiac events (MACE) at 1 year. The study aimed to evaluate the impact of in-hospital LVEF recovery on the primary study objective in patients treated with Impella for HR PCI and CS, respectively. (3) Results: The mean in-hospital change in LVEF was 10 ± 1% (p < 0.001) in the CS cohort and 3 ± 7% (p < 0.001) in the HR PCI group, achieved by 44% and 40% of patients, respectively. In the CS group, patients with less than 10% in-hospital LVEF recovery experienced higher rates of MACE at 1 year of follow-up (FU) (51% vs. 21%, HR 3.8, CI 1.7–8.4, p < 0.01). After multivariate analysis, LVEF recovery was the main independent protective factor for MACE at FU (HR 0.23, CI 0.08–0.64, p = 0.02). In the HR PCI group, LVEF recovery (>3%) was not associated with lower MACE at multivariable analysis (HR 0.73, CI 0.31–1.72, p = 0.17). Conversely, the completeness of revascularisation was found to be a protective factor for MACE (HR 0.11, CI 0.02–0.62, p = 0.02) (4) Conclusions: Significant LVEF recovery was associated with improved outcomes in CS patients treated with PCI during mechanical circulatory support with Impella, whereas complete revascularisation showed a significant clinical relevance in HR PCI.

Publisher

MDPI AG

Subject

Medicine (miscellaneous)

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