02660nam a2200301   4500001000800000005001700008007000300025008004100028040000800069041000800077100003400085245007900119300002500198520167400223650003301897650003201930650003201962650004301994700002602037700002602063700002802089700002202117700003002139700003102169773011002200942003102310999001702341ESSALUD20260903101808.0ta      t        pe ||||| |||| 00| 0 spa d  aBMG  aeng  aPerera, Divaka eAutor954527  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 GENERAL953638  aENFERMEDAD CORONARIA914895  aINFARTO DE MIOCARDIO913202  aSOPORTE CIRCULATORIO MECÁNICO954520  aRyan, Matthew 954528  aEzad, Saad M. 954529  aKhan, Sohail Q. 954530  aWebb, Ian 954531  aO’Kane, Peter D.954532  aWeerackody, Roshan 9545330 022717922676dMassachusetts NEJM GroupoNEJM015tThe New England Journal of Medicine wESSALUDx0028-4793  cARTICULOSe2026-08-31zsqb  c22920d22920