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Comparison of Impella and intra-aortic balloon pump in high-risk percutaneous coronary intervention: vascular complications and incidence of bleeding.

Boudoulas KD, Pederzolli A, Saini U, Gumina RJ, Mazzaferri EL, Davis M, Bush CA, Capers Q, Magorien R, Pompili VJ
Acute Card Care. 2012 14 (4): 120-4

PMID: 23215746 · DOI:10.3109/17482941.2012.741244

OBJECTIVE - Compare vascular complications and incidence of bleeding of Impella 2.5 and intra-aortic balloon pump (IABP) in high-risk percutaneous coronary interventions (PCI).

BACKGROUND - Large arterial sheath size for device insertion is associated with vascular and/or bleeding complications; gastrointestinal bleeding may also occur with anti-coagulation use.

METHODS - Patients with an acute coronary syndrome receiving Impella 2.5 or IABP during high-risk PCI were studied (13 Impella; 62 IABP). Vascular complications and incidence of bleeding were compared.

RESULTS - Post-procedure hematocrit was similar between groups. Blood transfusion occurred in 38.4% and 32.2% of patients in the Impella and IABP groups, respectively (P = NS); 65.3%, 30.7% and 3.8% of bleeding were due to vascular access site/procedure related, gastrointestinal and genitourinary, respectively. There was no statistical significant difference in vascular complications between the Impella and IABP groups (15.3% and 6.4% of patients, respectively); mesenteric ischemia (n = 1) and aortic rupture (n = 1) were only in the IABP group. In-hospital and one-year mortality were not statistically significant between groups.

CONCLUSION - Impella can be used as safely as IABP during high-risk PCI with similar vascular and bleeding complications. Importantly, approximately one third of bleeding was from the gastrointestinal system warranting careful prophylactic measures and monitoring.

MeSH Terms (16)

Acute Coronary Syndrome Aged Blood Transfusion Coronary Stenosis Female Gastrointestinal Hemorrhage Heart-Assist Devices Hematocrit Hemodynamics Hemorrhage Hospital Mortality Humans Intra-Aortic Balloon Pumping Male Middle Aged Retrospective Studies

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