02504nam a2200277   4500001000800000005001700008007000300025008004100028040000800069041000800077100002700085245007900112300002500191520167400216650002601890650002501916650002501941650003601966700001902002700001902021700002102040700001502061700002302076700002402099773010302123ESSALUD20260903101808.0ta      t        pe ||||| |||| 00| 0 spa d  aBMG  aeng  aPerera, Divaka eAutor  aLeft ventricular unloading in high-risk percutaneous coronary intervention  apáginas: 1779-1789  aBackground: Complex percutaneous coronary intervention (PCI) in patients with severely impaired left ventricular function carries a high risk of death and complications. Whether percutaneous left ventricular unloading improves outcomes remains unclear. Methods: We randomly assigned 300 patients with severe left ventricular dysfunction and extensive coronary artery disease in a 1:1 ratio to a strategy of elective unloading with a microaxial flow pump or to standard care during planned complex PCI. The primary outcome was a hierarchical composite that included death from any cause, disabling stroke, spontaneous myocardial infarction, hospitalization for cardiovascular causes, or periprocedural myocardial injury at a minimum of 12 months, as analyzed according to a win ratio. Results: A total of 148 patients were assigned to receive a microaxial flow pump and 152 to receive standard care. At a median of 22 months (interquartile range, 16 to 30), 36.6% of pairwise comparisons favored the microaxial flow pump, and 43.0% favored standard care (win ratio, 0.85; 95% confidence interval [CI], 0.63 to 1.15; difference, −6.4 percentage points; P=0.30). Death from any cause occurred in 47 patients in the microaxial-flow-pump group and 33 in the standard-care group (hazard ratio, 1.54; 95% CI, 0.99 to 2.41). There was no material between-group difference in the risk of bleeding or vascular complications. Conclusions: Among patients with severely impaired left ventricular function undergoing complex PCI, elective left ventricular unloading with a microaxial flow pump did not reduce the risk of major adverse clinical outcomes at a minimum of 12 months.

  aCARDIOLOGÍA GENERAL  aENFERMEDAD CORONARIA  aINFARTO DE MIOCARDIO  aSOPORTE CIRCULATORIO MECÁNICO  aRyan, Matthew   aEzad, Saad M.   aKhan, Sohail Q.   aWebb, Ian   aO’Kane, Peter D.  aWeerackody, Roshan 0 022717dMassachusetts NEJM GroupoNEJM015tThe New England Journal of Medicine wESSALUDx0028-4793