Association between standardized management algorithm and outcomes of patients undergoing high-risk percutaneous coronary interventions included in the IMPELLA-PL registry.

Abstract

Introduction: Impella CP is a percutaneous left ventricular assist device used in selected patients undergoing high‑risk percutaneous coronary interventions (HR‑PCIs). To improve outcomes of Impella‑supported HR‑PCI, institutional Impella programs have been developed.

Objectives: We evaluated the association between the use of a standardized periprocedural management algorithm and outcomes of patients undergoing HR‑PCI included in the national IMPELLA‑PL registry.

Patients and methods: Consecutive patients undergoing HR‑PCI supported with Impella CP (n = 253), enrolled in the IMPELLA‑PL registry between January 2014 and December 2021, were retrospectively divided into those fulfilling (n = 77) and not fulfilling (n = 176) the criteria of a standardized management algorithm, as proposed in the Roadmap Towards an Institutional Impella Program for HR‑PCI (ROAD TIP).

Results: Implementation of the standardized management algorithm allowed for selection of patients at a higher baseline risk, manifested by higher prevalence of acute coronary syndrome (P = 0.001), higher EuroScore (P = 0.02), and greater coronary artery disease complexity (P = 0.003). It also allowed for performing more complex PCI procedures, including a higher proportion of left main PCIs (P = 0.005), bifurcation PCIs (P <0.001), and use of calcium modification techniques (P = 0.02), more frequent Impella implantation before PCI (P = 0.002), and a higher proportion of ultrasound‑guided punctures (P <0.001). Despite higher baseline risk and greater procedural complexity, 12‑month outcomes of the patients treated according to the ROAD TIP algorithm were comparable to those of the individuals not fulfilling the algorithm criteria, who had a more favorable risk profile and underwent less complex procedures. In low‑volume centers, 12‑month mortality was lower in the standardized management group (P = 0.047), whereas in high‑volume centers, it was comparable between the groups.

Conclusions: Implementation of a dedicated management algorithm might improve outcomes of Impella‑assisted HR‑PCI, especially in low‑volume centers.