Two Large Studies Demonstrate Complete Revascularization with Impella Heart Pumps Improves Ejection Fraction and Long-Term Patient Outcomes
The PROTECT III and Restore EF studies reveal improved clinical outcomes for high-risk PCI patients using Impella heart pumps. Presented at TCT 2021, the PROTECT III study shows a 31% relative risk reduction in major adverse cardiovascular and cerebrovascular events (MACCE) at 90 days compared to previous studies. The Restore EF study indicated significant improvements in left ventricular ejection fraction (LVEF), heart failure, and anginal symptoms. These advancements reflect the evolving use of Impella technology, enhancing patient care in various healthcare settings.
- 31% relative risk reduction in MACCE (15.1% vs. 21.9%) at 90 days in PROTECT III study.
- 80% of patients in Restore EF study showed significant improvement in LVEF (35% to 45%).
- 76% reduction in NYHA classification III/IV heart failure symptoms in Restore EF study.
- 97% reduction in CCS classification III/IV anginal symptoms at follow-up.
- None.
“The contemporary data from these two prospective studies provide evidence that the adoption of Impella best practices is improving safety and reducing MACCE in the high-risk PCI patient population,” said
PROTECT III Final Results
The PROTECT III prospective study demonstrates improvement in 90-day clinical outcomes, completeness of revascularization, and safety, when compared to the PROTECT II Randomized Controlled Trial (RCT). The PROTECT II RCT found, when compared to intra-aortic balloon pump (IABP), Impella use led to a
Study authors analyzed patients in PROTECT III who would have qualified for PROTECT II, known as “PII-like” patients, and compared them to PROTECT II patients. PROTECT III patients had improved 90-day MACCE rates, compared to PROTECT II patients (
The study authors also note that PROTECT III patients, when compared to patients in PROTECT II:
- Were more complex, with more severe calcification, more rotational atherectomy and more vessels treated.
-
Had more complete revascularization, with
78% less hypotension during support (2.2% vs.10.2% , p=0.0004). -
Had improved in-hospital safety, with significantly fewer bleeding complications requiring transfusion (
1.2% vs.9.4% , p<0.001).
Restore EF Final Results
The Restore EF prospective study demonstrates the use of contemporary best practices with Impella in high-risk PCI significantly improves left ventricular ejection fraction (LVEF), heart failure symptoms, and anginal symptoms at 90-day follow-up in a wide variety of hospital settings including rural, urban, community and academic centers.
The study of 251 patients at 26 hospitals showed:
-
Significant improvement in LVEF from baseline to 90-day follow-up (
35% to45% p<0.0001). LVEF improvement at 90 days is the study’s primary endpoint. Restore EF is the latest study in a growing body of evidence demonstrating LVEF improvement with Impella-supported high-risk PCI. (see figure 2) -
Significant reduction of heart failure symptoms with
76% reduction inNew York Heart Association (NYHA) classification III/IV at follow-up (62% to15% p<0.001). (see figure 3) -
Significant reduction of anginal symptoms with
97% reduction inCanadian Cardiovascular Society (CCS) classification III/IV at follow-up (72% to2% p<0.0001). (see figure 3)
Advancement in Technology and Best Practices
Since PROTECT II, Impella-supported high-risk PCI has evolved to include the more powerful Impella CP with SmartAssist heart pump, which was used in about two-thirds of the patients in the Restore EF and PROTECT III studies.
“Advancement in technology, along with best practice learnings and operator experience has led to improvements in patient outcomes in contemporary practice,” said
The PROTECT series of studies and the Restore EF study are sponsored by
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FAQ
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