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, I2 = 78%), while vascular complications in 2.53% of patients (1.07–4.00, I2 = 89%) and post-procedural stroke in 2.77% of patients (0.50–6.05, I2 = 98%). Major bleeding occurred in 5.98% of patients (3.66–8.31, I2 = 90%) and post-procedural dialysis in 4.44% of patients (1.50–7.37, I2 = 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.