Introduction: Impella CP is a percutaneous left ventricle assist device used in selected patients undergoing high-risk percutaneous coronary interventions (HR-PCI). To improve outcomes after Impella-supported HR-PCI, institutional Impella programs have been developed.
Objectives: We evaluated the association between the standardized periprocedural management algorithm and outcomes of patients undergoing HR-PCI in the national IMPELLA-PL Registry.
Patients and methods: Consecutive patients undergoing HR-PCI with Impella CP (n=253) enrolled in the IMPELLA-PL registry from January 2014 until December 2021 were retrospectively divided into those treated with (n=77) and without (n=176) the standardized management ROAD TIP algorithm, as proposed in the Roadmap Towards an Institutional Impella Program for HR-PCI.
Results: Standardized management algorithm led to (i) selection of patients at higher baseline risk, including more frequent acute coronary syndrome presentation (P=0.001), higher EuroScore (P=0.02) and higher coronary artery disease complexity (P=0.003), (ii) more complex PCI procedures, including higher proportion of left main PCI (P=0.005), bifurcation PCI (P<0.001) and use of calcium modification techniques (P=0.02), more frequent Impella implantation before PCI (P=0.002), higher proportion of ultrasound-guided puncture (P<0.001). Despite higher baseline risk and procedural complexity, patients treated according to the standardized algorithm had comparable 12-month outcomes as patients not fulfilling the algorithm criteria, who were at lower risk and underwent less complex procedures. In the low-volume centers, 12-month mortality was lower in the standardized management group (P=0.047), whereas in the high-volume centers, it was comparable in both groups.
Conclusions: Implementation of the dedicated management algorithm might improve outcomes of Impella-assisted HR-PCI, especially in the low-volume centers.