Impact of Mean Blood Pressure Profiles in Percutaneous Left Ventricular Assist Device-Supported High-Risk Percutaneous Coronary Intervention: The PROTECT III Study.

backgroundPercutaneous left ventricular assist devices are used prophylactically to prevent hypotension during high-risk percutaneous coronary intervention. However, the impact of preprocedural hemodynamic profiles on procedural and clinical outcomes in these patients is unknown. METHODS AND

resultsPatients from the central venous access device PROTECT III registry (NCT04136392) were categorized according to preprocedural mean blood pressure (MBP). Procedural and in-hospital outcomes, including hypotensive episodes, need for prolonged percutaneous left ventricular assist device support, and in-hospital death, were compared between groups. We also assessed the relationship between preprocedural MBP and 90-day major adverse cardiovascular and cerebrovascular events, which included all-cause death, myocardial infarction, stroke/transient ischemic attack, and repeat revascularization, as well as with 1-year mortality. A total of 1159 patients underwent percutaneous left ventricular assist device-supported high-risk percutaneous coronary intervention and were stratified into 4 hemodynamic profiles of preprocedural MBP level: MBP>100 mm Hg (n=242), >90 to ≤100 mm Hg (n=264), >80 to ≤90 mm Hg (n=306), and ≤80 mm Hg (n=347). Lower preprocedural MBP was associated with baseline anemia, history of heart failure, left main disease, and transfer from another hospital. In-hospital and procedural adverse outcomes did not differ between the BP categories. However, 90-day major adverse cardiovascular and cerebrovascular events rates and 1-year mortality increased with decreasing baseline BP levels. The association between BP category and 1-year mortality remained significant after adjustment for other factors (hazard ratio [HR], 0.79 [95% CI, 0.71-0.88],

conclusionsIn a real-world cohort undergoing high-risk percutaneous coronary intervention with percutaneous left ventricular assist device support, there was no association between hemodynamic status and in-hospital outcomes. Lower preprocedural BP was associated with higher rates of 90-day major adverse cardiovascular and cerebrovascular events and 1-year mortality. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04136392.