Impella Support and Acute Kidney Injury During High-Risk PCI

October 16, 2019

Results from the cVAD Study™ on Renal Protection

Dr. Michael Flaherty presents data on acute kidney injury (AKI) in patients undergoing high-risk PCI with Impella® support. Dr. Flaherty is director, research-interventional cardiology at Baptist Health Medical Group, Heart and Vascular Center in Louisville, Kentucky.

In this presentation, Dr. Flaherty focuses on data from his 2017 and 2019 publications, both of which investigated the impact of Impella® support on acute kidney injury during high-risk PCI. The 2017 paper addresses the question: Does hemodynamic support from Impella during high-risk PCI protect against AKI when compared with the same revascularization strategy in patients without hemodynamic support? Results showed that Impella support during high-risk PCI was independently associated with a significant reduction in AKI (27.8% incidence of post-procedural AKI in patients with no support compared with 5.2% in patients with Impella support, p=0.001). The renal protective effect persisted despite preexisting chronic kidney disease (CKD) or reduced ejection fraction.

Dr. Flaherty then presents findings of the cVAD Study on renal protection published in his 2019 paper. The question posed for this study was: Does hemodynamic support from Impella during high-risk PCI decrease AKI relative to the calculated predicted risk of AKI in a high-risk PCI cohort? Results showed that when Impella support is used during high-risk PCI, the overall incidence of post-procedural AKI is significantly reduced relative to the predicted risk. Among Impella-supported patients, 4.9% developed AKI (exclusively stage 1) compared with a predicted rate of 21.9% (a 78% risk decrease) despite severely reduced EF, anemia, diabetes mellitus, prolonged procedure time, and contrast volume. In addition, observed AKI in this cohort was lower than the predicted AKI rates despite worsening CKD. However, when controlling for clinical and procedural variables, worsening renal function was a predictor for AKI.

Dr. Flaherty then examines how the reduction in AKI seen in the cVAD Study compares with a propensity matched control group. Looking at the PROTECT III substudy, he explains that AKI reduction persisted in this patient population with an AKI rate of 24.5% in the control (no support) group compared with 5.7% in the propensity matched PROTECT III population supported with Impella (p=0.0002).

Dr. Flaherty concludes his presentation posing the question “Can an Impella-assisted PCI strategy prevent AKI in high-risk patients?” He believes so, stating "In the end, AKI risk reduction will likely also translate into a mortality benefit, reduction in length of stay, and overall cost-effectiveness."

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