02659nam a2200301 4500 ESSALUD 20260903101808.0 ta t pe ||||| |||| 00| 0 spa d BMG eng Perera, Divaka Autor 54527 Left ventricular unloading in high-risk percutaneous coronary intervention páginas: 1779-1789 Background: 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. CARDIOLOGÍA GENERAL 53638 ENFERMEDAD CORONARIA 14895 INFARTO DE MIOCARDIO 13202 SOPORTE CIRCULATORIO MECÁNICO 54520 Ryan, Matthew 54528 Ezad, Saad M. 54529 Khan, Sohail Q. 54530 Webb, Ian 54531 O’Kane, Peter D. 54532 Weerackody, Roshan 54533 22717 22676 Massachusetts NEJM Group NEJM015 The New England Journal of Medicine ESSALUD 0028-4793 ARTICULOS 2026-08-31 sqb 22920 22920