Aleksandra Gąsecka, Arkadiusz Pietrasik, Tomasz Pawłowski, Jerzy Sacha, Marek Grygier, Gabriel Bielawski, Wojciech Balak, Adam Sukiennik, Paulina Burzyńska, Adam Witkowski, Mateusz Warniełło, Stanisław Bartuś, Łukasz Rzeszutko, Artur Pawlik, Mateusz Kaczyński, Robert Gil, Wiktor Kuliczkowski, Krzysztof Reczuch, Marcin Protasiewicz, Paweł Kleczyński, Piotr Wańczura, Sebastian Gurba, Michał Łomiak, Martyna Świerkowska, Kacper Karaban, Włodzimierz Skorupski, Maciej Zarębiński, Piotr Pawluczuk, Szymon Włodarczak, Adrian Włodarczak, Krzysztof Ściborski, Artur Telichowski, Mieszko Pluciński, Jarosław Hiczkiewicz, Karolina Konsek, Michał Hawranek, Mariusz Gąsior, Jan Peruga, Marcin Fiutowski, Robert Romanek, Piotr Kasprzyk, Dariusz Ciećwierz, Andrzej Ochała, Wojciech Wojakowski, Jacek Legutko, Janusz Kochman
{"title":"在IMPELLA-PL登记中，接受impella辅助的高风险经皮冠状动脉介入治疗的患者的程序特征和结果。","authors":"Aleksandra Gąsecka, Arkadiusz Pietrasik, Tomasz Pawłowski, Jerzy Sacha, Marek Grygier, Gabriel Bielawski, Wojciech Balak, Adam Sukiennik, Paulina Burzyńska, Adam Witkowski, Mateusz Warniełło, Stanisław Bartuś, Łukasz Rzeszutko, Artur Pawlik, Mateusz Kaczyński, Robert Gil, Wiktor Kuliczkowski, Krzysztof Reczuch, Marcin Protasiewicz, Paweł Kleczyński, Piotr Wańczura, Sebastian Gurba, Michał Łomiak, Martyna Świerkowska, Kacper Karaban, Włodzimierz Skorupski, Maciej Zarębiński, Piotr Pawluczuk, Szymon Włodarczak, Adrian Włodarczak, Krzysztof Ściborski, Artur Telichowski, Mieszko Pluciński, Jarosław Hiczkiewicz, Karolina Konsek, Michał Hawranek, Mariusz Gąsior, Jan Peruga, Marcin Fiutowski, Robert Romanek, Piotr Kasprzyk, Dariusz Ciećwierz, Andrzej Ochała, Wojciech Wojakowski, Jacek Legutko, Janusz Kochman","doi":"10.1016/j.carrev.2025.06.003","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Impella is a catheter-based, continuous blood flow left ventricle assist device used in selected patients undergoing high-risk percutaneous coronary interventions (HR PCI). We aimed to evaluate outcomes in patients undergoing Impella-assisted HR-PCI and identify independent predictors of 12-month mortality.</p><p><strong>Methods: </strong>Consecutive HR-PCI patients enrolled in the national, multicentre, retrospective IMPELLA-PL registry (n = 253) in 20 Polish interventional cardiological centres from October 2014 until December 2021 were included in the analysis. The main endpoints were (i) procedural success defined as revascularization of all preplanned lesions, (ii) device-related complications, (iii) 12-month mortality and major adverse cardiovascular events (MACE).</p><p><strong>Results: </strong>The majority of patients presented with multivessel disease including left main (63.6 %). The median Syntax Score II was 43.0 (32.4-55.0). The procedural success was achieved in 83.0 % of patients. Device-related complications included access site bleeding (14.6 %), limb ischemia (2.4 %) and hemolysis (1.6 %). The in-hospital MACE included 1 cardiosurgical intervention (0.4 %), 12 exacerbations of heart failure (4.7 %), 11 myocardial infarctions (4.3 %), 32 cases of acute kidney injury (12.6 %), 35 inflammatory complications (13.8 %) and 32 major bleeding complications (13.4 %). In-hospital mortality rate was 8.3 %, 12-month mortality rate was 18.2 % and MACE rate post-discharge was 22.5 %. The 12-month-mortality was increased by pre-existing, atrial fibrillation (OR 3.50, 95 % CI 1.38-8.95) and chronic kidney disease (OR 2.77, 95 % CI 1.06-7.26) and decreased by Impella removal in the cath-lab (OR 0.11, 95 % CI 0.02-0.76) and RAAS inhibitor use (OR 0.26, 95 % CI 0.08-0.89).</p><p><strong>Conclusions: </strong>Despite high anatomical complexity of coronary artery disease of patients included in the IMPELLA-PL registry, the procedural success rate was relatively high and the mortality relatively low.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Procedural characteristics and outcomes of patients undergoing Impella-assisted high-risk percutaneous coronary interventions in the IMPELLA-PL registry.\",\"authors\":\"Aleksandra Gąsecka, Arkadiusz Pietrasik, Tomasz Pawłowski, Jerzy Sacha, Marek Grygier, Gabriel Bielawski, Wojciech Balak, Adam Sukiennik, Paulina Burzyńska, Adam Witkowski, Mateusz Warniełło, Stanisław Bartuś, Łukasz Rzeszutko, Artur Pawlik, Mateusz Kaczyński, Robert Gil, Wiktor Kuliczkowski, Krzysztof Reczuch, Marcin Protasiewicz, Paweł Kleczyński, Piotr Wańczura, Sebastian Gurba, Michał Łomiak, Martyna Świerkowska, Kacper Karaban, Włodzimierz Skorupski, Maciej Zarębiński, Piotr Pawluczuk, Szymon Włodarczak, Adrian Włodarczak, Krzysztof Ściborski, Artur Telichowski, Mieszko Pluciński, Jarosław Hiczkiewicz, Karolina Konsek, Michał Hawranek, Mariusz Gąsior, Jan Peruga, Marcin Fiutowski, Robert Romanek, Piotr Kasprzyk, Dariusz Ciećwierz, Andrzej Ochała, Wojciech Wojakowski, Jacek Legutko, Janusz Kochman\",\"doi\":\"10.1016/j.carrev.2025.06.003\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Impella is a catheter-based, continuous blood flow left ventricle assist device used in selected patients undergoing high-risk percutaneous coronary interventions (HR PCI). We aimed to evaluate outcomes in patients undergoing Impella-assisted HR-PCI and identify independent predictors of 12-month mortality.</p><p><strong>Methods: </strong>Consecutive HR-PCI patients enrolled in the national, multicentre, retrospective IMPELLA-PL registry (n = 253) in 20 Polish interventional cardiological centres from October 2014 until December 2021 were included in the analysis. The main endpoints were (i) procedural success defined as revascularization of all preplanned lesions, (ii) device-related complications, (iii) 12-month mortality and major adverse cardiovascular events (MACE).</p><p><strong>Results: </strong>The majority of patients presented with multivessel disease including left main (63.6 %). The median Syntax Score II was 43.0 (32.4-55.0). The procedural success was achieved in 83.0 % of patients. Device-related complications included access site bleeding (14.6 %), limb ischemia (2.4 %) and hemolysis (1.6 %). The in-hospital MACE included 1 cardiosurgical intervention (0.4 %), 12 exacerbations of heart failure (4.7 %), 11 myocardial infarctions (4.3 %), 32 cases of acute kidney injury (12.6 %), 35 inflammatory complications (13.8 %) and 32 major bleeding complications (13.4 %). In-hospital mortality rate was 8.3 %, 12-month mortality rate was 18.2 % and MACE rate post-discharge was 22.5 %. 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引用次数: 0
摘要
背景：Impella是一种基于导管的左心室持续血流辅助装置，用于接受高风险经皮冠状动脉介入治疗（HR PCI）的患者。我们的目的是评估接受impella辅助HR-PCI的患者的预后，并确定12个月死亡率的独立预测因素。方法：从2014年10月至2021年12月，在波兰20个介入性心脏病中心的全国性、多中心、回顾性IMPELLA-PL登记中心（n = 253）登记的连续HR-PCI患者纳入分析。主要终点是(i)手术成功（定义为所有预先计划病变的血运重建），（ii）器械相关并发症，（iii） 12个月死亡率和主要不良心血管事件（MACE）。结果：以左主干多支病变为主（63.6%）。句法评分II的中位数为43.0（32.4-55.0）。手术成功率为83.0%。器械相关并发症包括通路部位出血（14.6%）、肢体缺血（2.4%）和溶血（1.6%）。住院MACE包括心外科干预1例（0.4%），心衰加重12例（4.7%），心肌梗死11例（4.3%），急性肾损伤32例（12.6%），炎症并发症35例（13.8%），大出血并发症32例（13.4%）。住院死亡率为8.3%，12个月死亡率为18.2%，出院后MACE率为22.5%。先前存在的房颤（OR 3.50, 95% CI 1.38-8.95）和慢性肾脏疾病（OR 2.77, 95% CI 1.06-7.26）增加了12个月的死亡率，在导尿管实验室中移除Impella （OR 0.11, 95% CI 0.02-0.76）和使用RAAS抑制剂（OR 0.26, 95% CI 0.08-0.89）降低了死亡率。结论：尽管IMPELLA-PL登记的患者冠状动脉疾病解剖复杂性高，但手术成功率相对较高，死亡率相对较低。
Procedural characteristics and outcomes of patients undergoing Impella-assisted high-risk percutaneous coronary interventions in the IMPELLA-PL registry.
Background: Impella is a catheter-based, continuous blood flow left ventricle assist device used in selected patients undergoing high-risk percutaneous coronary interventions (HR PCI). We aimed to evaluate outcomes in patients undergoing Impella-assisted HR-PCI and identify independent predictors of 12-month mortality.
Methods: Consecutive HR-PCI patients enrolled in the national, multicentre, retrospective IMPELLA-PL registry (n = 253) in 20 Polish interventional cardiological centres from October 2014 until December 2021 were included in the analysis. The main endpoints were (i) procedural success defined as revascularization of all preplanned lesions, (ii) device-related complications, (iii) 12-month mortality and major adverse cardiovascular events (MACE).
Results: The majority of patients presented with multivessel disease including left main (63.6 %). The median Syntax Score II was 43.0 (32.4-55.0). The procedural success was achieved in 83.0 % of patients. Device-related complications included access site bleeding (14.6 %), limb ischemia (2.4 %) and hemolysis (1.6 %). The in-hospital MACE included 1 cardiosurgical intervention (0.4 %), 12 exacerbations of heart failure (4.7 %), 11 myocardial infarctions (4.3 %), 32 cases of acute kidney injury (12.6 %), 35 inflammatory complications (13.8 %) and 32 major bleeding complications (13.4 %). In-hospital mortality rate was 8.3 %, 12-month mortality rate was 18.2 % and MACE rate post-discharge was 22.5 %. The 12-month-mortality was increased by pre-existing, atrial fibrillation (OR 3.50, 95 % CI 1.38-8.95) and chronic kidney disease (OR 2.77, 95 % CI 1.06-7.26) and decreased by Impella removal in the cath-lab (OR 0.11, 95 % CI 0.02-0.76) and RAAS inhibitor use (OR 0.26, 95 % CI 0.08-0.89).
Conclusions: Despite high anatomical complexity of coronary artery disease of patients included in the IMPELLA-PL registry, the procedural success rate was relatively high and the mortality relatively low.
期刊介绍：
Cardiovascular Revascularization Medicine (CRM) is an international and multidisciplinary journal that publishes original laboratory and clinical investigations related to revascularization therapies in cardiovascular medicine. Cardiovascular Revascularization Medicine publishes articles related to preclinical work and molecular interventions, including angiogenesis, cell therapy, pharmacological interventions, restenosis management, and prevention, including experiments conducted in human subjects, in laboratory animals, and in vitro. Specific areas of interest include percutaneous angioplasty in coronary and peripheral arteries, intervention in structural heart disease, cardiovascular surgery, etc.
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