Left ventricular unloading in high-risk percutaneous coronary intervention
Perera, Divaka Ryan, Matthew Ezad, Saad M Khan, Sohail Q Webb, Ian O'Kane, Peter D Weerackody, Roshan Dodd, Matthew Kwok, Matthew Laidlaw, Lynn
Perera, Divaka
Ryan, Matthew
Ezad, Saad M
Khan, Sohail Q
Webb, Ian
O'Kane, Peter D
Weerackody, Roshan
Dodd, Matthew
Kwok, Matthew
Laidlaw, Lynn
Abstract
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.
MIDER Authors
Affiliations
King's College London; Guy's and St. Thomas' NHS Foundation Trust; University Hospitals Dorset NHS Foundation Trust; University Hospitals Birmingham NHS Foundation Trust; King's College Hospital NHS Foundation Trust; Bart's Health NHS Trust; London School of Hygiene and Tropical Medicine; Royal Wolverhampton NHS Trust; University Hospitals Bristol NHS Foundation Trust; Newcastle Upon Tyne Hospitals NHS Foundation Trust; Manchester University NHS Foundation Trust; University Hospitals of Leicester NHS Trust; Mid and South Essex NHS Foundation Trust; Swansea Bay University Health Board; Belfast Health and Social Care Trust; NHS Golden Jubilee; University Hospital Southampton NHS Foundation Trust; Royal Papworth Hospital NHS Foundation Trust; Liverpool Heart and Chest Hospital NHS Foundation Trust
Date
2026-03-29
Type
Article
Collections
Citation
Perera D, Ryan M, Ezad SM, Khan SQ, Webb I, O'Kane PD, Weerackody R, Dodd M, Kwok M, Laidlaw L, Van Dyck L, Wrigley B, Strange JW, Bagnall A, Fath-Ordoubadi F, Panoulas VF, Ladwiniec A, Davies JR, Chase A, Owens CG, Watkins S, Rahman H, Pareek N, Rathod K, Rawlins J, Evans R, Hoole SP, Stables RH, Curzen N, Clayton T; CHIP-BCIS3 Investigators. Left Ventricular Unloading in High-Risk Percutaneous Coronary Intervention. N Engl J Med. 2026 May 7;394(18):1779-1789. doi: 10.1056/NEJMoa2515704. Epub 2026 Mar 29.