000			02659nam a2200301 4500
001			ESSALUD
005			20260903101808.0
007			ta
008			t pe ||||| |||| 00| 0 spa d
040			_aBMG
041			_aeng
100			_aPerera, Divaka _eAutor _954527
245			_aLeft ventricular unloading in high-risk percutaneous coronary intervention
300			_apáginas: 1779-1789
520			_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.
650			_aCARDIOLOGÍA GENERAL _953638
650			_aENFERMEDAD CORONARIA _914895
650			_aINFARTO DE MIOCARDIO _913202
650			_aSOPORTE CIRCULATORIO MECÁNICO _954520
700			_aRyan, Matthew _954528
700			_aEzad, Saad M. _954529
700			_aKhan, Sohail Q. _954530
700			_aWebb, Ian _954531
700			_aO’Kane, Peter D. _954532
700			_aWeerackody, Roshan _954533
773	0		_022717 _922676 _dMassachusetts NEJM Group _oNEJM015 _tThe New England Journal of Medicine _wESSALUD _x0028-4793
942			_cARTICULOS _e2026-08-31 _zsqb
999			_c22920 _d22920