Introduction:
High risk percutaneous coronary interventions (PCI) may be preceded by elective support device insertion, though the evidence for such a practice is relatively weak. We sought to analyze the changing trends and predictors for prophylactic support device insertion in these patients over the last 20 years.
Methods:
Retrospective analysis of all patients who underwent PCI at Cleveland Clinic between 1993 - 2013 with or without support device insertion was performed. Trends for device insertion in high risk patients undergoing PCI, like those in clinical shock, acute myocardial infarction (MI) and unprotected left main intervention over the last 20 years were reviewed. Predictors for support device insertion in these patients from 1993-2000 were compared to those from 2001-2013.
Results:
A total of 666 elective support devices were inserted prior to high risk PCI from 1993-2013. Between 1993-2000, acute myocardial infarction (MI) (OR: 10.05), ejection fraction < 40% (OR: 8.31) and unprotected left main intervention (OR: 4.59) were the three most significant predictors for device insertion prophylactically. Between 2001-2013, unprotected left main intervention (OR: 9.91), ejection fraction < 40% (OR: 5.61) and clinical shock (OR: 5.24) were the biggest predictors, with the odds of support device insertion in acute MI in absence of clinical shock reduced to 1.96.
Conclusions:
There has been a significant decrease in the proportion of high risk PCIs with elective support device insertion, especially in those performed in patients with acute myocardial infarction in absence of shock.
Unprotected Left Main Intervention
