IABP vs Impella®: Incidence of Bleeding and Vascular Complications
- Patients undergoing high-risk PCI often require additional hemodynamic support, particularly with the help of ventricular assist devices.
- There is no significant difference between Impella 2.5® and IABP in terms of bleeding risk and vascular complications.
High-risk patients with acute coronary syndrome (ACS) often require additional cardiac support during a protected percutaneous coronary intervention (PCI). Two of the most commonly used devices to improve hemodynamics during high-risk PCI are the intra-aortic balloon pump (IABP) and the Impella 2.5 left ventricular assist device. Despite previously demonstrated efficacy,1 bleeding risk and vascular complications are not uncommon with these devices. A study from Acute Cardiac Care compared these risks among IABP and Impella 2.5 to determine device-related outcomes in patients with ACS.2
This retrospective study analyzed patients receiving IABP (n=62) or Impella 2.5 (n=13) during high-risk PCI. Physician decision dictated which patient received which device; this study was not randomized. The formation of arteriovenous (AV) fistula, mesenteric ischemia, aortic rupture, and leg ischemia defined the vascular complications related to the procedure. Also, the incidence of bleeding was defined as a patient requiring ≥1 unit of packed red blood cell (PRBC) transfusion.
There was no statistically significant difference between the two groups in terms of left ventricular systolic function, coronary artery anatomy, or degree of stenoses. PCI was was performed on either the left main artery (18.6%) or the left anterior descending artery (64.0%).
Additionally, there was no difference between each group in regard to vascular complications. Overall, only 2 patients in the Impella group and 4 patients in the IABP group experienced vascular complications.
A significant decrease in hematocrit levels post-procedure was observed in both groups for Impella at 48 h and 72 h, and IABP at 24 h, 48 h, and 72 h. Differences in postprocedural hematocrit was also insignificant among each group. PRBC transfusion was basically equivalent to the Impella (38.4%) and IABP (38.5%) groups. Medical records failed to demonstrate the source of bleeding in some of patients; however, gastrointestinal bleeding was shown to be the source in around 30.7% of patients.
While there was no in-hospital deaths for the Impella group and 13 deaths in the IABP group, the small number of patients did not achieve statistical significance. Mortality was mainly related to myocardial infarction (n=10). Although a higher percentage of patients with STEMI were in the IABP group (59.6% vs 15.3%), the authors believe that the mortality findings may be due to enhanced hemodynamic support with the Impella heart pump.
- Iliodromitis KE, Kahlert P, Plicht B, et al. High-risk PCI in acute coronary syndromes with Impella LP 2.5 device support. Int J Cardiol. 2011;153(1):59-63.
- Boudoulas KD, Pederzolli A, Saini U, et al. Comparison of Impella and intra-aortic balloon pump in high-risk percutaneous coronary intervention: vascular complications and incidence of bleeding. Acute Card Care. 2012;14(4):120-124.
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/