TY  - BOOK
AU  - Ben-Dor, Itsik
AU  - Bernardo, Nelson L
AU  - Case, Brian
AU  - Chen, Yuefeng
AU  - Hashim, Hayder
AU  - Khalid, Nauman
AU  - Musallam, Anees
AU  - Rogers, Toby
AU  - Satler, Lowell F
AU  - Shea, Corey
AU  - Shlofmitz, Evan
AU  - Waksman, Ron
AU  - Yerasi, Charan
AU  - Zhang, Cheng
TI  - High-Risk Percutaneous Coronary Intervention of Native Coronary Arteries Without Mechanical Circulatory Support in Acute Coronary Syndrome Without Cardiogenic Shock
SN  - 0002-9149
PY  - 2021///
KW  - *Angina, Unstable/su [Surgery]
KW  - *Assisted Circulation
KW  - *Non-ST Elevated Myocardial Infarction/su [Surgery]
KW  - *Percutaneous Coronary Intervention/ae [Adverse Effects]
KW  - *Postoperative Complications/ep [Epidemiology]
KW  - *ST Elevation Myocardial Infarction/su [Surgery]
KW  - Aged
KW  - Aged, 80 and over
KW  - Angina, Unstable/mo [Mortality]
KW  - Feasibility Studies
KW  - Female
KW  - Hospital Mortality
KW  - Humans
KW  - Male
KW  - Middle Aged
KW  - Non-ST Elevated Myocardial Infarction/mo [Mortality]
KW  - Retrospective Studies
KW  - Risk Factors
KW  - ST Elevation Myocardial Infarction/mo [Mortality]
KW  - Survival Rate
KW  - MedStar Heart & Vascular Institute
KW  - MedStar Washington Hospital Center
KW  - Interventional Cardiology Fellowship
KW  - Journal Article
N2  - Widespread utilization of mechanical circulatory support (MCS) for high-risk percutaneous coronary intervention (PCI) remains controversial, with a lack of randomized supporting evidence and associated risk of device-related complications. We investigated whether high-risk PCI of native coronary arteries without elective MCS in patients with acute coronary syndrome (ACS) is safe and feasible. We performed a single-center, retrospective analysis for ACS patients meeting American College of Cardiology high-risk criteria: unprotected left main disease, last remaining conduit, ejection fraction <35%, 3-vessel coronary artery disease, severe aortic stenosis, or severe mitral regurgitation. Patients with cardiogenic shock and those undergoing PCI of the bypass grafts were excluded. Major in-hospital and 30-day cardiovascular outcomes were assessed. From 2003 through 2018, 499 patients (847 lesions) with unstable angina pectoris (UAP), 1218 patients (1807 lesions) with non-ST-elevation myocardial infarction (NSTEMI), and 868 patients (1260 lesions) with ST-segment elevation myocardial infarction (STEMI) underwent high-risk PCI. Procedural success was achieved in 97.2% of UAP, 98.3% of NSTEMI, and 96.6% of STEMI patients. In-hospital and 30-day all-cause mortality were as follows: UAP, 2%; NSTEMI, 2.1%; and STEMI 4.7%. Bailout intra-aortic balloon pump was required in 1.6% of UAP, 3.1% of NSTEMI, and 10.3% of STEMI patients. Major complications for UAP, NSTEMI, and STEMI were, respectively: target lesion revascularization (2.3%, 1.4%, and 1.5%), stroke or transient ischemic attack (0.8%, 0.6%, and 1.3%), acute renal failure (8.2%, 7.2%, and 10.2%), major bleeding (1.6%, 3.1%, and 8.5%). In conclusion, our results show that high-risk PCI without elective MCS is safe and feasible in most ACS patients, challenging professional societies' current recommendations. A randomized trial comparing unprotected versus protected high-risk PCI for non-shock ACS patients is warranted. Copyright (c) 2021. Published by Elsevier Inc
UR  - https://dx.doi.org/10.1016/j.amjcard.2021.07.014
ER  -