Optimizing revascularization in the high-risk heart: Impella™-facilitated percutaneous coronary intervention in multivessel coronary artery disease with reduced left ventricular ejection fraction and mitral regurgitation.

While no statistically significant difference in major adverse events was observed at 30 days, follow-up analyses at 90 days showed a trend toward improved outcomes with Impella, reaching statistical significance in per-protocol and selected post hoc analyses. 22 , 27 For the first time, the most recent European guidelines explicitly recommend the use of an mAFP in selected patients undergoing HR-PCI at experienced centres (class IIb recommendation). 1 Furthermore, in patients with significant functional MR, MCS with an Impella device offers a compelling mechanistic option.

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