71 Outcome in patients undergoing high-risk pci using impella circulatory support - 10 year experience
Notice bibliographique
Résumé
<h3>Introduction</h3> The use of Impella in the setting of high-risk percutaneous coronary intervention (PCI) has been introduced in clinical practice in the last few years in selected hospitals, giving a chance for revascularization to a sensible number of patients who are usually unsuitable for cardiac surgery due to high risks. In addition, some of these patients present pre-procedural cardiogenic shock, further increasing the rate of morbidity and mortality. Our purpose was to assess outcome of patients undergoing Impella-assisted high-risk PCI in our 10 year experience and to assess possible predictors of adverse events. <h3>Methods</h3> From May 2008 to September 2018 patients undergoing Impella-assisted high-risk PCI were enrolled. Clinical, laboratory, echocardiographic, angiographic and procedural data were collected. Coronary artery disease burden was graded using the British Cardiovascular Intervention Society Jeopardy Score (BCIS-JS). In-hospital MACCE were recorded. During routine follow-up visits data including MACCE, hospital admissions for heart failure, Canadian Cardiovascular Society (CCS) angina grade and New York Heart Association (NYHA) functional class were recorded. Long-term survival Kaplan Meier analysis was performed according to national registry death data. <h3>Results</h3> A total of 80 consecutive patients were enrolled (71.2±13.7 years, male gender 73.8%), 21 (26.3%) presenting with stable angina, 53 (66.3%) with NSTE-ACS and 6 (7.5%) with STEMI. 67 (83.8%) of them showed multivessel disease, 42 (52.5%) unprotected left main disease, 47 (58.8%) severe left ventricle systolic dysfunction (LVEF<30%), 10 (12.5%) pre-procedural cardiogenic shock. Median BCIS-JS was 10 [8,00; 12,00]. In-hospital MACCE occurred in 16 (20%) patients with death in 15 (18.8%). Median time to first follow-up visit for survivors was 105 (64.5; 282.0) days: at this time 11 (13.8%) patients had MACCE, 3 (3.8%) had hospital admissions for heart failure, median CCS was 0.00 (0.00; 0.00) and median NYHA was 1.00 (1.00; 2.00). Mean survival time (procedure to death, months) was 21 months (C.I. 14.4 - 29.0). Multivariate logistic regression analysis for possible predictors of in-hospital MACCE was performed including the variables showing a p value <0.100 at univariate analysis, i.e. pre-procedural cardiogenic shock [OR 9.00, C.I. (2.1–37.6), p=0.003] and CK peak [OR 1.00, C.I. (1.0–1.0), p=0.051]. Pre-procedural cardiogenic shock was the only predictor [OR 7.058, C.I. (1.2–40.6), p=0.029] of in-hospital MACCE. No significant predictors of MACCE at follow-up were found at logistic regression analysis. <h3>Conclusion</h3> In our 10 year experience of Impella-assisted high-risk PCI, 20% patients had in-hospital MACCE and mean survival was 21 months. At follow up, MACCE rate was less than 4% and both angina and heart failure symptoms were well controlled. Pre-procedural cardiogenic shock was the only predictor of in-hospital MACCE. <h3>Conflict of Interest</h3> No conflict of interest
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».