{
  "abstract": "Background The use of Impella devices to provide periprocedural circulatory support during high-risk percutaneous coronary intervention (PCI) has expanded, particularly in patients with severe left ventricular dysfunction or complex, high-risk coronary anatomy. However, the requirement for large-bore arterial access introduces the potential for vascular and bleeding complications. This study examines the incidence and clinical consequences of vascular complications in patients who had Impella-assisted PCI.Methods A retrospective analysis was conducted on consecutive patients who underwent Impella-protected PCI at a tertiary cardiac center. Baseline demographic, clinical, and procedural characteristics were collected, and follow-up data were obtained for up to 24 months. Vascular complications were classified according to VARC-3 criteria. The primary endpoint was the incidence of major adverse cardiovascular events (MACE) at 24 months, defined as a composite of all-cause mortality, target vessel revascularization, myocardial infarction, or stroke.Results A total of 105 patients underwent Impella-supported PCI between 2009 and 2023. The mean age of the study population was 71 ± 13 years, and 26% were female. The cohort exhibited a high burden of comorbidities: 75% had hypertension, 46% diabetes mellitus, 10% peripheral vascular disease, 53% prior myocardial infarction, 21% previous PCI, 11% prior CABG, and EuroScore was 8% [7%–10%]. The mean eGFR was 55.5 ± 20.3 mL/min/1.73m 2. Most patients presented with ACS (79%), while 21% underwent elective procedures. Severe LV dysfunction (EF < 30%) was present in 65% of patients. Cardiogenic shock was documented in 16% prior to PCI; 12% were ventilated, and 6% had out-of-hospital cardiac arrest. Another mechanical circulatory support modality was required in addition to Impella in 11% of cases.Regarding angiographic characteristics, 59% had severe unprotected left main disease, and 81% had severe proximal LAD lesions. Drug-eluting stents were used in 97% of cases. PCI was attempted in three or more vessels in 27%, and 47% required implantation of three or more stents. Intravascular imaging guidance was used in 49% of procedures. Rotational atherectomy was performed in 23%.Impella access was obtained via the right femoral artery in 54% and the left femoral artery in 46%. Access closure was achieved with two ProGlides in 50% of patients, with alternative closure strategies used in the remainder.Pre-procedural vascular assessment was available in 22 patients (21%), using either Doppler ultrasound (7 cases) or CT angiography (15 cases). There was no statistically significant difference in vascular complication rates between patients who underwent pre-procedural vascular imaging (13.6%, 3/22) and those who did not (12.0%, 10/83) [p = 1.000, OR:1.15] (figure 1) (table 1).A total of 13 patient (12%) experienced vascular access-related complications, and their bleeding severity was categorised according to the Bleeding Academic Research Consortium (BARC) classification. Among these, 3 (2.9%) were major vascular complications that required ≥3 units of blood transfusion, whereas the remaining were minor complications. Major complications included 1 retroperitoneal haemorrhage and 1 major bleeding with acute limb ischemia, both of which required endovascular surgery and led to hospital death (Type 5), and 1 patient had a major vascular hematoma requiring vascular surgical repair (Type 3b). Minor complications included 2 distal embolisations, 1 femoral artery dissection, and the remaining were access-site bleeding of varying severitythat resolved before discharge. Of these, 4 required blood transfusion during admission (Type 3A).The rate of composite procedural complications was 17%. Emergency CABG was required in two patients (2%); embolic stroke occurred in one (1%), renal replacement therapy in four (4%), gastrointestinal bleeding in two (2%), and cardiac tamponade in three (3%). The overall in-hospital mortality was 22%. At two-year follow-up, the incidence of MACE was 40%.The cohort was stratified into two groups based on the occurrence of vascular access-related complications (vascular group = 13; non-vascular group = 92). No significant differences were observed in baseline or procedural characteristics between the two groups. There was no statistical difference in MACE incidence between the two groups at 24 months (38.5% vs 40.2%, p > 0.99) (figure 2).Conclusions In this real-world cohort of high-risk Impella-supported PCI, major vascular complications were infrequent (2.9%) and were not associated with increased MACE incidence at 24-month follow-up. Pre-procedural vascular imaging did not demonstrate a significant reduction in vascular complication rates, though the small imaging subgroup limits the power to detect statistical clinical differences. The high in-hospital mortality reflects the inherent procedural complexity and patients’ comorbidities.Abstract 496 Figure 1Abstract 496 Figure 2",
  "authors": [
    {
      "affiliations": [
        "Department of Cardiology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom"
      ],
      "name": "Ahmed Elsherif"
    },
    {
      "affiliations": [
        "Department of Cardiology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom"
      ],
      "name": "Hossameldin Hussein"
    },
    {
      "affiliations": [
        "Department of Cardiology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom"
      ],
      "name": "Anwar Hussain"
    },
    {
      "affiliations": [
        "Department of Cardiology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom"
      ],
      "name": "Sophia Khattak"
    },
    {
      "affiliations": [
        "Department of Cardiology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom"
      ],
      "name": "Ameenathul Fawzy"
    },
    {
      "affiliations": [
        "Department of Cardiology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom"
      ],
      "name": "Sharvari Mahajan"
    },
    {
      "affiliations": [
        "Department of Cardiology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom"
      ],
      "name": "Gomathy Suresh"
    },
    {
      "affiliations": [
        "Department of Cardiology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom"
      ],
      "name": "Saideep Chakka"
    },
    {
      "affiliations": [
        "Department of Cardiology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom",
        "Aston University, Birmingham, United Kingdom"
      ],
      "name": "Farhan Shahid"
    },
    {
      "affiliations": [
        "Department of Cardiology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom",
        "Institute for Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom"
      ],
      "name": "Peter Ludman"
    },
    {
      "affiliations": [
        "Department of Cardiology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom",
        "Institute for Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom"
      ],
      "name": "Sohail Khan"
    }
  ],
  "title": "496 Vascular complications and clinical outcomes in impella-assisted high-risk percutaneous coronary intervention: a 15-year retrospective cohort analysis",
  "uid": "628ed610-4524-5f1c-bf36-9018b09fc6e0"
}