Dr. John Lasala Discusses Benefits of Protected PCI at Scripps 2015

October 29, 2015

Protected percutaneous coronary intervention (PCI) with the Impella® 2.5 heart pump was the focus of the talk by Dr. John Lasala, Director of Interventional Cardiology at the Washington University School of Medicine in St. Louis, Missouri. His talk was titled “Preparing for a Growing Population in the Cath Lab" and was presented at the 26th annual 2015 Scripps Cardiovascular Interventions Conference on Tuesday, October 27, 2015. Dr. Lasala was a featured speaker in the preconference session called “A New Procedure in the Cath Lab: Protected PCI Treating Complex and Higher-Risk Indicated Patients (CHIP).”

Dr. Lasala began by describing the Impella 2.5, which is the only hemodynamic support device proven safe and effective for use in treating elective and urgent high-risk PCI patients, and which may reduce peri and post-procedural adverse events. The Impella heart pump is designed to protect the patient hemodynamically during a high-risk PCI procedure.

ppci_patientsHigh-risk PCI with hemodynamic support can be appropriate for certain high-risk patients with complex coronary artery disease. Such patients are hemodynamically stable, often have an ejection fraction ≤35%, and comorbid conditions such as heart failure, peripheral vascular disease, complex lesions, diabetes, advanced age, unstable angina, non ST-segment elevation myocardial infarction, or prior surgeries.

Dr. Lasala described the hemodynamic support provided by the Impella 2.5. When the Impella 2.5 is turned on, systolic pressure, diastolic pressure, and mean arterial pressure increase in patients undergoing high risk PCI, as described by Maini et al. 2012. Dr. Lasala contrasted the Impella 2.5 with the intra aortic balloon pump (IABP), which, in the normal course, increases only diastolic pressure.

Dr. Lasala cited the study by Kovacic et al. (2015), which demonstrated that the Impella 2.5 maintained patient hemodynamics and allowed physicians the time to perform a more complete revascularization of blood vessels compared to IABP. Complete revascularization with the Impella 2.5 was a factor, which led to a 29% reduction in major adverse cardiac and cerebral events (MACCE) compared to IABP, as demonstrated during the PROTECT II trial (Dangas et al. 2014).

The clinical benefits of the Impella 2.5 for high-risk PCI patients include improved left ventricular ejection fraction at follow up (Burzotta et al. 2008; Dixon et al. 2009; Maini et al. 2012; O’Neill et al. 2012), decreased heart failure symptoms (O’Neill et al. 2012), required fewer days in the hospital (Gregory et al. 2013; Maini et al. 2014) and a reduction in repeat PCI procedures (Gregory et al. 2013).

Conclusion

The Impella 2.5 is safe and effective for treating elective and urgent high risk PCI patients, who are hemodynamically stable, and who present with severe coronary artery disease and a depressed left ventricular ejection fraction. The Impella 2.5 further enables patients with complex coronary artery disease to be treated successfully with high risk PCI to reduce the need for repeat high-risk PCI procedures and obtain more complete revascularization..

Next Steps:


To learn more about the Impella® platform of heart pumps, including important risk and safety information associated with the use of the devices, please visit: www.protectedpci.com/indications-use-safety-information/

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