A “Treasure Trove” of Complete Revascularization Data

“I think it’s quite impressive that actually we were sitting on a treasure trove of data,” Stelios Tsintzos emphasizes, referring to the complete revascularization data Vasileios Panoulas, MD, examined from PROTECT II, PROTECT III and RESTORE EF. Dr. Panoulas, a consultant interventional cardiologist at the Harefield Hospital in London, UK, released his analysis of this data at EuroPCR 2023.

“I think the importance of digging in these particular studies is that the data quality was there,” Dr. Panoulas underlines, “In the PROTECT II and the PROTECT III studies, they were adjudicated from core laboratories… so it’s accurate data.” Dr. Panoulas states that literature from the past decade supports “the more complete the revasc, the better the outcomes we get.” 

Dr. Panoulas presents the hypothesis that using a percutaneous LVAD, such as an Impella® heart pump, potentially helps to achieve higher levels of revascularization. “If you’ve got support, you have the time to do good lesion preparation, you have the time to do good bifurcation techniques, you have the time to achieve the best results.” Looking at the data, he reports that about 40% of the patients supported with Impella achieved complete revascularization, defined as a residual SYNTAX score less than two. In the intra-aortic balloon pump (IABP) group, only 20% achieved complete revascularization. “Despite not having complete revasc in mind,” Dr. Panoulas emphasizes, “they achieved double figures compared to balloon pump in revasc.” 

In addition, Dr. Panoulas reports that 70% of the patients in the group supported with Impella heart pumps achieved what is considered “acceptable results” with a residual SYNTAX score below eight, while only about 30% of patients in the IABP group achieved these results. In practical terms, he states, this means that only three out of 10 patients in the IABP group achieved a “decent” completeness of revascularization.

Dr. Panoulas also discusses the implications of these findings for ongoing Impella heart pump trials such as PROTECT IV and next steps for this analysis.