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

Authors

Saad M Ezad, Matthew Ryan, Sohail Q Khan, Vasileios F Panoulas, Andrew Ladwiniec, Thomas Keeble, Ian Webb, Aadil Shaukhat, Jonathan Hinton, Matthew E Li Kam Wa, Aish Sinha, Holly Morgan, Kalpa De Silva, Antonis Pavlidis, James Spratt, Thomas Johnson, Simon Walsh, Adrian P Banning, David Hildick-Smith, Peter O'Kane, Nicholas Barrett, Matthew Dodd, Abdel Douiri, Tim Clayton, Divaka Perera, CHIP-BCIS3 Investigators

Published in

Journal of the American College of Cardiology. Jul 28, 2026. Epub Jul 28, 2026.

Abstract

Elective left ventricular (LV) unloading during high-risk percutaneous coronary intervention (PCI) is hypothesized to mitigate hemodynamic instability and myocardial stunning, but has not been evaluated in a randomized trial.
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.
Patients with severe LV systolic dysfunction undergoing complex PCI were randomized to elective LV unloading with an mAFP or standard care. Invasive hemodynamics were assessed using pulmonary artery catheterization at baseline and post-PCI. The coprimary outcomes were systolic blood pressure reduction, loss of pulse pressure (LOPP), and requirement for inotropes. Secondary outcomes included changes in cardiac index, LV filling pressure, and frequency of peri-procedural myocardial injury.
Of 125 eligible patients, 97 were enrolled (50 mAFP; 47 standard care). Baseline cardiac index was 2.10 ± 0.55 L/min/m². The incidence of 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). 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). 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.
In patients undergoing complex PCI, elective LV unloading with mAFP reduced inotrope requirements but increased LOPP and did not prevent myocardial stunning. (Controlled Trial of High-risk Coronary Intervention With Percutaneous Left Ventricular Unloading [CHIP-BCIS3]; NCT05003817).

PMID:
42554527
Bibliographic data and abstract were imported from PubMed on 05 Aug 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.