Background: Impella-assisted PCI has become widely utilized in select patients with high-risk features. They are traditionally performed using dual arterial access. A single access for high-risk PCI (SHiP) technique has emerged as an alternative to reduce bleeding and vascular complications, but there is a lack of robust evidence comparing both strategies.
Methods: A single-center retrospective study included adults planned for Impella-assisted High-Risk PCI, with either SHiP or standard dual arterial access. The primary outcome was a composite of any vascular injury or access site bleeding. Secondary outcomes included severe access-site bleeding, AKI, stroke, length of stay, survival to discharge, 30-day readmission, and procedural metrics. Multivariable logistic regression was used to evaluate the association between access strategy and the primary outcome.
Outcome: Among 100 patients, 28 underwent SHiP, and 72 underwent dual access. The primary composite outcome occurred less frequently with SHiP (25.0% vs 51.4%; p=0.025), with lower rates of access-site and severe access-site bleeding and comparable rates of vascular injury. (Figure 1A) After adjusting for clinical and procedural covariates, dual-access (vs SHIP) remained independently associated with higher odds of the primary outcome (aOR 3.8, 95% CI 1.08–13.41, p=0.037). Other short-term clinical and procedural outcomes were comparable between groups. (Figure 1B)
Conclusion: Impella-assisted high-risk PCI using a SHiP strategy is associated with a lower incidence of procedural complications, such as bleeding events, compared with traditional dual-access PCI.
