This prespecified substudy of the CHIP-BCIS3 RCT evaluated elective LV unloading with a microaxial flow pump (mAFP) vs. standard care in 97 patients with severe LV systolic dysfunction undergoing complex PCI, measuring hemodynamic instability and postprocedural myocardial stunning via pulmonary artery catheterization.
mAFP reduced inotrope use (RR: 0.57; 95% CI: 0.34–0.97) but significantly increased loss of pulse pressure (LOPP; RR: 7.83; 95% CI: 2.53–24.24), which was itself linked to peri-procedural myocardial injury (OR: 3.00; 95% CI: 1.00–9.03); systolic BP reduction, cardiac index change, and PCWP change did not differ between groups.
Small sample size (n=97 of 125 eligible); substudy design limits power for some endpoints; LOPP is a device-specific artifact of mAFP that may confound interpretation of hemodynamic instability.
Elective mAFP use in complex PCI reduces inotrope requirements but does not prevent myocardial stunning and introduces LOPP, which is associated with myocardial injury — clinicians should weigh these trade-offs before routine prophylactic mAFP use.
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