Hemodynamic support in pci
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This document discusses hemodynamic support devices used in the cath lab, including the Impella system. It outlines the types of indications for cath lab hemodynamic support, such as elective high-risk PCI, PCI for cardiogenic shock, and recent high-risk acute coronary syndrome. The document reviews evidence from the PROTECT II trial that demonstrates improved left ventricular function and NYHA class with the Impella system, as well as superior outcomes compared to intra-aortic balloon pumps. It concludes that the Impella system provides better hemodynamic support than intra-aortic balloon pumps, especially when placed pre-PCI, for high-risk PCI and cardiogenic shock patients.
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Hemodynamic support in pci
- 1. Hemodynamic Support in PCI
- 4. Types of Hemodynamic Support in the Cath Lab
- 5. Hemodynamic Support Devices for the Cath Lab
- 6. Indications for Cath Lab Hemodynamic Support Cath Lab hemodynamic support Elective high- risk PCI PCI in Cardiogenic shock • Impaired LV function • PCI to a single last patent conduit • PCI of vessel(s) supplying a large myocardial territory Recent high-risk ACS • Heterogeneous • Non-atherosclerotic CAD • Underlying LV impairment, scar, valvular disease or dysrhythmia
- 23. Evidence for IMPELLA system
- 24. PROTECT II Trial Design
- 26. LVEF and NYHA Improvement Post PCI
- 27. PROTECT II: Per Protocol MAE (N=427)
- 28. PROTECT II MAE Outcome Pre-specified High Risk PCI Without Atherectomy Group Per Protocol (N=374)
- 29. USPELLA Registry: Impella® Insertion Timing (N= 154) O’Neill et al, J Interven Cardiol 2013;9999:1-11
- 30. Outcome: Impella Pre or Post PCI
- 31. Outcome By Support Strategy Survival to discharge
- 32. Conclusions • Impella & IABP are most frequently used hemodynamic support devices in the cath lab that facilitate performance of high-risk elective PCI & during cardiogenic shock • Impella provides better balance of efficacy, safety & feasibility during high risk PCI & provides superior hemodynamic support compared to IABP, especially if placed pre- PCI