Study On Prophylactic Mechanical Ventilation And IABP In Intervention Of Complex High-risk Indicated Patients

Objectives: This study sought to evaluate the effect and feasibility of IMV and IABP during PCI in Complex High-Risk and Indicated Patients(CHIP).Method: Patients were recruited in the Fujian Medical University Union Hospital from January 2017 to December 2019,who received high-risk percutaneous coronary intervention(Hr-PCI).According to the intraoperative support measures,they were divided into 4 groups: NS group(without any support,n = 45),IABP group(IABP-only,n = 16),IMV group(IMV-only,n = 42)and IABP + IMV group(IMV+IABP support,n = 29).The primary end point was the combination of intra-procedural severe adverse cardiac events(SACE)and device-associated severe events(DASE).SACE composed of cardiogenic death(CD),acute heart failure with acute pulmonary edema(HF-PE),cardiogenic shock(CS),malignant arrhythmia(MA);DASE is a complication caused by instruments,composed of infection(pulmonary or systemic),bleeding,ischemia or other serious complications.The secondary end point was the one-year cumulative incidence of MACE,including cardiogenic death(CD),myocardial infarction(MI),target vessel revascularization,worsened heart failure,and stroke.Result: Except for the higher proportion of Killip Grade 3/4 in IABP and IMV+IABP group,the baseline clinical and lesion’s characteristics were comparable between the groups.SACE of NS,IABP,IMV and IMV+IABP groups were 42.22%,18.75%,26.19% and 13.79% respectively(p=0.011).The incidence of CS in IABP group(12.50%,P=0.011)and IMV+IABP group(10.34%,P=0.010)was significantly lower than that in NS group(37.78%).However,there was no significant difference in CD,HF-PE,MA among the groups.DASE in NS,IABP,IMV and IMV+IABP groups were 9.76%,26.67%,35.00% and 39.28% respectively(p < 0.05).The incidence of pulmonary infection in IMV group(32.50%,P=0.005)and IMV+IABP group(32.14%,P=0.011)was significantly higher than that in NS group(7.32%)without significant difference in systemic infection,bleeding,ischemia or other serious complications among the groups.At one year follow-up,there was no significant difference in MACE,cardiac death,recurrent myocardial infarction,target vessel revascularization,heart failure worsening and stroke among the groups.Conclusion: For CHIP received PCI,prophylactic IABP and the combination of IABP and IMV is generally safe and feasible for it would lead to a reduction in cardiogenic shock and provide guarantee for operation,though mechanical ventilation may increase pulmonary infections.However,whether IMV and IABP or their combination can improve the long-term outcomes remains uncertain and warrants to be verified by large-scale clinical trials.