Propensity matched analysis of single access technique for Impella-assisted unprotected left main percutaneous coronary intervention.

Background: The single access for high-risk percutaneous coronary intervention (SHiPCI) technique is an intriguing alternative to traditional dual access Impella-assisted PCI, potentially reducing access-site complications. Current data is limited to retrospective case studies.

Objective: To analyze procedural complications and clinical outcomes of SHiPCI.

Methods: This single-center retrospective observational study evaluated consecutively admitted patients undergoing high-risk unprotected left main PCI (UPLM-PCI) from 2018 through 2023. Patients were grouped according to index strategy of single or dual access Impella-assisted UPLM-PCI, and propensity score matching without replacement was used to match patients 1:1. The primary outcome was a composite of all-cause in-hospital mortality, major bleeding, vascular access site complications, and blood transfusion.

Results: Six-hundred patients underwent UPLM-PCI during the study period, and one hundred patients were matched (50 patients per group). There were no significant differences in baseline characteristics between the two groups. Up-front balloon tamponade assistance was higher in the dual access group (14 % vs 4.0 %, p = 0.027), and rate of successful hemostasis post-closure was lower (82 % vs 100 %, p = 0.001). The primary composite outcome occurred in 7 patients (14 %) in the single access group, compared to 16 patients (32 %) in the dual access group (p = 0.033). Patients in the dual-access group had higher rates of major bleeding (17 % vs 2 %, p = 0.014).

Conclusions: SHiPCI compared to standard dual access for Impella-assisted UPLM-PCI demonstrated a lower rate lower rate of the composite outcome, driven primarily by a lower rate of major bleeding. Prospective randomized controlled trials are needed to delineate the efficacy and safety of SHiPCI.