Short term outcomes of Impella circulatory support for high-risk percutaneous coronary intervention a systematic review and meta-analysis

Objective Aim of this study is to evaluate short term safety and efficacy of Impella in high risk percutaneous coronary intervention (HR-PCI) population. Background While several studies demonstrated the clinical significance of Impella in HR-PCI, few data exist about its impact on short term outcome. Methods All studies reporting short term outcomes of PCI with any Impella device were included. The primary endpoint was either in-hospital or 30-day mortality, while vascular complications, post-procedural stroke, post-procedural dialysis and bleeding complications were assessed as secondary outcomes. Results Nine studies with 7448 patients were included. Median age was 69.5 years old (67-73), with a mean ejection fraction of 29.7% (20%-39%) and a Syntax score of 30.2 (25. 5-33, interquartile [IQR]). Impella 2.5 was the most commonly used axial flow pump used to support these PCIs (88.7%). In-hospital death was observed in 5.09% of patients (95% confidence interval [CI] 3.69-6.49, I-2 = 78%), while vascular complications in 2.53% of patients (1.07-4.00, I-2 = 89%) and post-procedural stroke in 2.77% of patients (0.50-6.05, I-2 = 98%). Major bleeding occurred in 5.98% of patients (3.66-8.31, I-2 = 90%) and post-procedural dialysis in 4.44% of patients (1.50-7.37, I-2 = 93% all CI 93%). Conclusion Use of Impella in high risk PCI appears to have an acceptable rate of complication, especially regarding vascular complications and major bleedings.