Live Relay: Impella Supported High-Risk PCI of RCA/LAD/LCx w/ OCT Guidance for OA Use - 3/17/24

Case & Plan:
63 years, Male
Risk Factors include
Controlled Hypertension
Controlled Hyperlipidemia
Uncontrolled IRDM
SAQ-7 score: 45, Current Smoker
Presented in 1/27/2024 with AWSTEMI @OSH with hypotension and EF 30%. Cath revealed extensive 3 V CAD, pt was optimized and referred for CABG: which was declined by the family after Heart team discussion.
Pt has known low EF but no documented CAD in the past: on ACEI only. Recent echo revealed EF 30-37% with small LV thrombus and placed on warfarin.
ASA, Warfarin, Carvidolol, Atorvastatin, Empagliflozin, Furosemide, Albuterol (intolerant tp Entresto)
Cath @ OSH on 1/27/2024 revealed 3 V CAD, syntax score 35, LVEF 32% and STS risk score 5.2%. IABP was placed post Cath which was removed after 48hrs. Heart team discussion considered pt very high surgical risk and recommended high risk Protected PCI.

[@areenal-taie6836]

Great teaching case !
Thanks Dr Sharma and Dr Kini

[@Docsammy]

If no indication for atherectomy, this wont need hemodynamic support..evident by no change in pulse pressure with inflations.

[@SaminSharma-ol2kz]

Agree that this case was borderline for the Impella use and favorable points are thrombotic LAD potential for slow flow, EDP 22mmHg and EF 32%.

[@jwilson3985]

Changing enrollment criteria is a problem I mentioned from the beginning. If the median EF is >30% the substrates will be too healthy to benefit from pLVAD. Sad to see. Should have been

[@SaminSharma-ol2kz]

I personally think that 35% LVEF criteria for Protect IV is ideal and then we can have sub analysis of

[@jwilson3985]

@@SaminSharma-ol2kz sub analyses prove nothing and are purely hypothesis-generating so that’s not correct. The real “Samin” knows this :).