EuroPCR 2023: How to Optimize High-risk PCI Patient Outcome: Discussion & Audience Interaction

Following presentations in the EuroPCR 2023 session titled “How to optimize high-risk patient outcome?” moderator Javier Escaned, MD, and speakers Nikos Werner, MD, Dirk Westermann, MD, and Vasileios Panoulas, MD, answer questions.

Dr. Westermann highlights changes in treatement strategies over time in the data Dr. Panoulas presented from an analysis of PROTECT II, PROTECT III, and RESTORE EF data. This analysis tested the hypothesis that Protected PCI may be associated with a greater extent of revascularization and, thus, may contribute to superior clinical outcomes compared to PCI of equivalent complexity utilizing intra-aortic balloon pump (IABP). Dr. Panoulas explains that "the datasets did not mandate complete revascularization", noting, “So it’s nice to see that the operators just feel more comfortable to do a more complete job.” 

Dr. Werner asks about not only extent, but quality of revascularization and Dr. Panoulas explains that there was a higher trend in use of calcium modification in cases supported with Impella® devices. Dr. Westermann emphasizes the importance of data that will be coming from the ongoing PROTECT IV randomized controlled trial (RCT), which has currently enrolled about half of the total 1250 patients.

Dr. Escaned asks Dr. Werner why operators perform more extensive revascularization in patients supported with mechanical circulatory support (MCS). Dr. Werner explains that operators are sensitive to signals that the patient is unstable or deteriorating and that the quality of revascularization in a stable condition will not be the same as the quality of revascularization in a patient who is experiencing drops in blood pressure with every balloon dilation, rotational atherectomy run, or Shockwave intravascular lithotripsy balloon inflation.

The panel also addresses a question from the audience pertaining to PROTECT III endpoints and Impella pump positioning during support.