Comparison of Impella and intra-aortic balloon pump in high-risk percutaneous coronary intervention: vascular complications and incidence of bleeding.
Comparison of Impella and intra-aortic balloon pump in high-risk percutaneous coronary intervention: vascular complications and incidence of bleeding.
复制标题
DOI：
10.3109/17482941.2012.741244
复制
发表时间：
2012-12-01
期刊：
影响因子：
--
通讯作者：
Pompili, Vincent J
中科院分区：
文献类型：
--
作者：
Boudoulas, Konstantinos Dean;Pederzolli, Andrew;Pompili, Vincent J
目的：比较Impella 2.5和主动脉内球囊反搏(IABP)在高危经皮冠状动脉介入治疗(PCI)中的血管并发症和出血发生率。背景：置入装置的大动脉鞘尺寸与血管和/或出血并发症相关；抗凝治疗也可能发生胃肠道出血。方法：对急性冠状动脉综合征患者在高危经皮冠状动脉介入治疗中应用Impella 2.5或IABP(13例Impella；62例IABP)。比较两组血管并发症和出血发生率。结果：两组术后血细胞比容相似。Impella组和IABP组的输血率分别为38.4%和32.2%(P=NS)，分别为65.3%、30.7%和3.8%。Impella组和IABP组血管并发症发生率分别为15.3%和6.4%，差异无统计学意义(P>0.05)，仅IABP组发生肠系膜缺血和主动脉破裂各1例。两组患者的住院死亡率和1年死亡率差异无统计学意义。结论：Impella在血管和出血并发症相似的高危冠状动脉介入治疗中可以与IABP一样安全地使用。重要的是，大约三分之一的出血来自胃肠道系统，需要谨慎的预防措施和监测。
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.