B-4 | Clinical Outcomes of Patients with Transient Loss of Pulsatility During Hemodynamically Supported High Risk PCI
Bibliographic record
Abstract
BackgroundHigh risk percutaneous coronary intervention (HRPCI) is typically defined by patient risk factors, anatomic complexity, and hemodynamic status. Patients experiencing loss of pulsatility (LOP) during coronary intervention are transiently dependent on mechanical circulatory support (MCS). Examining these patients may allow better understanding of those most at risk of hemodynamic collapse during HRPCI.MethodsPatients enrolled into the Protect III study who underwent HRPCI with MCS and had automated Impella controller logs capturing real time hemodynamics, were included in the study. LOP was defined as an average pulse pressure <20 mmHg for ≥ 5 seconds. Clinical characteristics and outcomes were then compared.Results302 patients were treated at 38 sites between 2017-2020. 148 patients (49.0%) experienced LOP. Age, gender and comorbidities including baseline left ventricular ejection fraction were similar between groups. Systolic blood pressure (SBP) (118.6 vs 129.8 p<0.01), mean arterial pressure (MAP) (86.9 vs 91.6, p=0.01), and cardiac output (CO) (4.4 vs 5.5, p=0.02) were lower in patients with LOP; while cardiac output deficit (COD) (-0.3 vs -1.1, p<0.01) and heart rate (HR) (78.0 vs 73.0 bpm, p=0.01) were higher. Anatomic complexity including the vessel treated, number of vessels treated, use of atherectomy, PCI of a last remaining conduit, pre-PCI syntax score, and change in syntax score were all similar between groups. Patients experiencing LOP had longer procedural times (2.5 vs 2.1 hours, p<0.01) and ICU duration (5.7 vs 3.6 days, p<0.01). Patients with LOP had higher rates of mortality during the hospitalization (8.1 vs 2.6%, p=0.04) and 90-day major adverse cardiac and cerebrovascular events (MACCE) (23.5 vs 8.8%, p<0.01).ConclusionsHemodynamic status at the time of HRPCI as opposed to patient comorbidities or anatomic complexity is associated with LOP. Patients undergoing HRPCI with decreased SBP, MAP, CO and increased COD and HR are more likely to experience LOP which was associated with increasing rates of MACCE. The value of obtaining invasive hemodynamics pre-PCI requires further study and will be investigated in a sub-study of the Protect IV randomized control trial.DisclosuresM. B. Basir: consultant for Abbott Vascular, Abiomed, Cardiovascular Systems, Chiesi, and Zoll.: Consulting; D. Bentley: Abiomed: Employed or Salary; K. Kunkel: Abiomed: Consulting; Cardiovascular Systems, Inc.: Consulting; Shockwave: Consulting; K. Alaswad: consultant and speaker for Boston Scientific, Abbott Cardiovascular, Teleflex, and CSI: Consulting; A. Kaki: Abiomed: Consulting and Speaker Bureau; Shockwave: Consulting and Speaker Bureau; G. W. Stone: Cook Medical: Speaker Bureau; Terumo: Speaker Bureau; Valfix Medical: Consulting; TherOx: Consulting; Vascular Dynamics: Consulting; Robocath: Consulting; HeartFlow: Consulting; Gore: Consulting; Ablative Solutions: Consulting; Miracor: Consulting; Neovasc: Consulting; V-Wave: Consulting; Abiomed: Consulting; MAIA Pharmaceuticals: Consulting; Vectorious: Consulting; Reva: Consulting; Cardiomech: Consulting; W. W. O’Neill: Abiomed: Consulting; Abbott: Consulting; Boston Scientific Corp.: Consulting; Medtronic: Consulting; A. Lemor Nothing to disclose. M. S. Megaly Nothing to disclose. M. Alqarqaz Nothing to disclose. A. K. Khandelwal Nothing to disclose. S. Kalra Nothing to disclose. D. Burkhoff Nothing to disclose. J. W. Moses Nothing to disclose. D. S. Pinto Nothing to disclose. BackgroundHigh risk percutaneous coronary intervention (HRPCI) is typically defined by patient risk factors, anatomic complexity, and hemodynamic status. Patients experiencing loss of pulsatility (LOP) during coronary intervention are transiently dependent on mechanical circulatory support (MCS). Examining these patients may allow better understanding of those most at risk of hemodynamic collapse during HRPCI. High risk percutaneous coronary intervention (HRPCI) is typically defined by patient risk factors, anatomic complexity, and hemodynamic status. Patients experiencing loss of pulsatility (LOP) during coronary intervention are transiently dependent on mechanical circulatory support (MCS). Examining these patients may allow better understanding of those most at risk of hemodynamic collapse during HRPCI. MethodsPatients enrolled into the Protect III study who underwent HRPCI with MCS and had automated Impella controller logs capturing real time hemodynamics, were included in the study. LOP was defined as an average pulse pressure <20 mmHg for ≥ 5 seconds. Clinical characteristics and outcomes were then compared. Patients enrolled into the Protect III study who underwent HRPCI with MCS and had automated Impella controller logs capturing real time hemodynamics, were included in the study. LOP was defined as an average pulse pressure <20 mmHg for ≥ 5 seconds. Clinical characteristics and outcomes were then compared. Results302 patients were treated at 38 sites between 2017-2020. 148 patients (49.0%) experienced LOP. Age, gender and comorbidities including baseline left ventricular ejection fraction were similar between groups. Systolic blood pressure (SBP) (118.6 vs 129.8 p<0.01), mean arterial pressure (MAP) (86.9 vs 91.6, p=0.01), and cardiac output (CO) (4.4 vs 5.5, p=0.02) were lower in patients with LOP; while cardiac output deficit (COD) (-0.3 vs -1.1, p<0.01) and heart rate (HR) (78.0 vs 73.0 bpm, p=0.01) were higher. Anatomic complexity including the vessel treated, number of vessels treated, use of atherectomy, PCI of a last remaining conduit, pre-PCI syntax score, and change in syntax score were all similar between groups. Patients experiencing LOP had longer procedural times (2.5 vs 2.1 hours, p<0.01) and ICU duration (5.7 vs 3.6 days, p<0.01). Patients with LOP had higher rates of mortality during the hospitalization (8.1 vs 2.6%, p=0.04) and 90-day major adverse cardiac and cerebrovascular events (MACCE) (23.5 vs 8.8%, p<0.01). 302 patients were treated at 38 sites between 2017-2020. 148 patients (49.0%) experienced LOP. Age, gender and comorbidities including baseline left ventricular ejection fraction were similar between groups. Systolic blood pressure (SBP) (118.6 vs 129.8 p<0.01), mean arterial pressure (MAP) (86.9 vs 91.6, p=0.01), and cardiac output (CO) (4.4 vs 5.5, p=0.02) were lower in patients with LOP; while cardiac output deficit (COD) (-0.3 vs -1.1, p<0.01) and heart rate (HR) (78.0 vs 73.0 bpm, p=0.01) were higher. Anatomic complexity including the vessel treated, number of vessels treated, use of atherectomy, PCI of a last remaining conduit, pre-PCI syntax score, and change in syntax score were all similar between groups. Patients experiencing LOP had longer procedural times (2.5 vs 2.1 hours, p<0.01) and ICU duration (5.7 vs 3.6 days, p<0.01). Patients with LOP had higher rates of mortality during the hospitalization (8.1 vs 2.6%, p=0.04) and 90-day major adverse cardiac and cerebrovascular events (MACCE) (23.5 vs 8.8%, p<0.01). ConclusionsHemodynamic status at the time of HRPCI as opposed to patient comorbidities or anatomic complexity is associated with LOP. Patients undergoing HRPCI with decreased SBP, MAP, CO and increased COD and HR are more likely to experience LOP which was associated with increasing rates of MACCE. The value of obtaining invasive hemodynamics pre-PCI requires further study and will be investigated in a sub-study of the Protect IV randomized control trial. Hemodynamic status at the time of HRPCI as opposed to patient comorbidities or anatomic complexity is associated with LOP. Patients undergoing HRPCI with decreased SBP, MAP, CO and increased COD and HR are more likely to experience LOP which was associated with increasing rates of MACCE. The value of obtaining invasive hemodynamics pre-PCI requires further study and will be investigated in a sub-study of the Protect IV randomized control trial.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.214 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".