Impact of Left Ventricular Unloading on Hemodynamics and Stunning in Complex PCI: A CHIP-BCIS3 Substudy.

This prespecified substudy of the CHIP-BCIS3 (Controlled Trial of High-risk Coronary Intervention With Percutaneous Left Ventricular Unloading) trial evaluated whether elective LV unloading with a microaxial flow pump (mAFP) reduces hemodynamic instability and postprocedural stunning.

这项CHIP-BCIS3（经皮左心室卸载的高风险冠状动脉干预控制试验）的预定子研究评估了选择性使用微型轴流泵（mAFP）进行LV卸载是否能减少血流动力学不稳定和术后顿抑。

Methods

Patients with severe LV systolic dysfunction undergoing complex PCI were randomized to elective LV unloading with an mAFP or standard care.

正在接受复杂PCI的严重LV收缩功能障碍患者被随机分配到选择性使用mAFP进行LV卸载或标准护理。

Invasive hemodynamics were assessed using pulmonary artery catheterization at baseline and post-PCI.

使用肺动脉导管在基线和PCI后评估侵入性血流动力学。

The coprimary outcomes were systolic blood pressure reduction, loss of pulse pressure (LOPP), and requirement for inotropes.

主要共结局是收缩压降低、脉压丧失（LOPP）和需要正性肌力药物的需求。

Secondary outcomes included changes in cardiac index, LV filling pressure, and frequency of peri-procedural myocardial injury.

次要结局包括心脏指数、LV充盈压的变化以及围手术期心肌损伤的频率。

Results

Of 125 eligible patients, 97 were enrolled (50 mAFP; 47 standard care).

在125名符合条件的患者中，有97名被纳入研究（50名使用mAFP；47名接受标准护理）。

Baseline cardiac index was 2.10 ± 0.55 L/min/m2.

基线心脏指数为2.10 ± 0.55 L/min/m2。

The incidenceof systolic blood pressure reduction was similar between groups (relative risk [RR]: 0.86; 95% CI: 0.58-1.29), whereas inotrope use was lower with mAFP (RR: 0.57; 95% CI: 0.34-0.97).

两组间收缩压降低的发生率相似（相对风险[RR]：0.86；95%置信区间[CI]：0.58-1.29），而使用正性肌力药物在mAFP组中较低（RR：0.57；95% CI：0.34-0.97）。

LOPP was more frequent with mAFP (RR: 7.83; 95% CI: 2.53-24.24) and was associated with peri-procedural myocardial injury (OR: 3.00; 95% CI: 1.00-9.03).

使用mAFP的患者中，低血压的发生更为频繁（RR：7.83；95% CI：2.53-24.24），并且与围手术期心肌损伤相关（OR：3.00；95% CI：1.00-9.03）。

Changes in cardiac index (-0.25 vs -0.24 L/min/m2; P = 0.20) and pulmonary capillary wedge pressure (2 vs 3 mm Hg; P = 0.79) were similar between groups.

两组间心脏指数的变化（-0.25 vs -0.24 L/min/m2；P = 0.20）和肺毛细血管楔压（2 vs 3 mm Hg；P = 0.79）相似。

Conclusions

In patients undergoing complex PCI, elective LV unloading with mAFP reduced inotrope requirements but increased LOPP and did not prevent myocardial stunning.

在进行复杂PCI的患者中，选择性左心室卸载使用mAFP可以减少正性肌力药物的需求，但会增加低血压的发生，并且未能预防心肌顿抑。

(Controlled Trial of High-risk Coronary Intervention With Percutaneous Left Ventricular Unloading [CHIP-BCIS3]; NCT05003817).

（高风险冠状动脉干预与经皮左心室卸载的对照试验[CHIP-BCIS3]；NCT05003817）。