Day 2 Speakers at CHIP Event Discuss Evaluating Patients for Protected PCI
Day 2 of the course entitled “CHIP: Hemodynamic Support and Complex PCI” in Fort Lauderdale, FL on January 24, 2016 began with a discussion of complex PCI and hemodynamics followed by interactive case-based discussions on the use of hemodynamic support in complex high-risk and indicated patients or CHIP patients.
Dr. John Lasala from Washington University School of Medicine, St. Louis, Missouri, took a close look at the surgical turn down patient, who may have the characteristics listed on the slide below:
Dr. Lasala recommended the use of the heart team to evaluate each patient and their specific medical condition. The heart team consists of an interventional cardiologist and a cardiothoracic surgeon who evaluates the patient’s medical condition and suggests the best treatment options for each patient—such as medical treatment, coronary artery bypass surgery (CABG), or percutaneous coronary intervention (PCI).
An example was a case presentation of a patient who had 5 hospitalizations in one year with repeated non ST-segment elevation myocardial infarction. No angiogram was conducted, and the patient was referred for a heart transplant. The surgeon requested an angiogram, which indicated the patient had severe left main disease.
Dr. Lasala moderated a discussion about the preferred first treatment option for this patient: coronary revascularization, evaluating this patient for PCI with left ventricular assist device, or heart transplant. Evaluation of clinical results showed this patient’s left ventricular ejection fraction was 20%. Because of the low ejection fraction, the discussants decided to proceed with Protected PCI as the treatment of choice for this patient. After the Protected PCI procedure, the angiogram and results of clinical tests indicated an excellent outcome.
This patient was typical of high-risk patients with complex coronary artery disease who are hemodynamically stable, have left ventricular ejection fraction ≤35%, and comorbid conditions such as heart failure, peripheral vascular disease, complex lesions, diabetes, advanced age, and unstable angina. Dr. Lasala concluded that these patients—who have the highest risk—also have the greatest potential for benefit.
Dr. Jeffrey Moses, New York Presbyterian Hospital/Columbia University Medical Center, New York agreed and noted he considers hemodynamic support in the situations noted on the slide below:
Dr. Moses emphasized the goal of complex PCI is complete revascularization. Complete revascularization is associated with reduced mortality, major adverse cardiovascular and cerebrovascular events (MACCE), myocardial infarction, and repeat revascularizations.
- Listen to a webinar about the heart team model
- Learn more about the clinical data associated with Protected PCI
The Impella 2.5 system is a temporary (<6 hours) ventricular support device indicated for use during high-risk percutaneous coronary interventions (PCI) performed in elective or urgent, hemodynamically stable patients with severe coronary artery disease and depressed left ventricular ejection fraction, when a heart team, including a cardiac surgeon, has determined high-risk PCI is the appropriate therapeutic option. Use of the Impella 2.5 in these patients may prevent hemodynamic instability which can result from repeat episodes of reversible myocardial ischemia that occur during planned temporary coronary occlusions and may reduce peri- and post-procedural adverse events.
Protected PCI and use of the Impella 2.5 is not right for every patient. Patients may not be able to be treated with Impella if they have certain pre-existing conditions, which a cardiologist can determine, such as: severe narrowing of the heart valve, severe peripheral artery disease, clots in blood vessels, or a replacement heart valve or certain heart valve deficiencies. Additionally, use of Impella has been associated with risks, including, but not limited to valvular and vascular injury, bleeding, and limb ischemia in certain patients. Learn more about the Impella devices’ approved indications for use, as well as important safety and risk information at www.protectedpci.com/indications-use-safety-information/.