[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-437170-105":59,"doc-detail-437170-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","mechanical-circulatory-support-for-high-risk-percutaneous-coronary-intervention-is-it-a-choice-or-chance-that-determines-outcomes-editorial","Mechanical Circulatory Support for High-Risk Percutaneous Coronary Intervention: Is It a Choice or Chance That Determines Outcomes? - Editorial","","Editorial analyzing mechanical circulatory support (MCS) use during high-risk percutaneous coronary intervention (PCI). Compares contemporary device practice—percutaneous ventricular assist device (PVAD) versus intra-aortic balloon pump (IABP)—and discusses limits of observational comparisons, including selection bias, confounding from real-world decision-making, and inability to distinguish prophylactic versus bailout use. Summarizes a large 2018–2024 administrative database study without shock, reporting lower 90-day mortality and major adverse events with PVAD.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/mechanical-circulatory-support-for-high-risk-percutaneous-coronary-intervention-is-it-a-choice-or-chance-that-determines-outcomes-editorial/437170/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/mechanical-circulatory-support-for-high-risk-percutaneous-coronary-intervention-is-it-a-choice-or-chance-that-determines-outcomes-editorial/437170.png","ImageObject",300,407,{"name":92,"@type":93},"Stanley","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-05","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",14,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why is mechanical circulatory support important in high-risk PCI?","Question",{"text":113,"@type":114},"High-risk PCI can impair coronary perfusion and limit complete revascularization, worsening short- and long-term outcomes. MCS devices may reduce hemodynamic compromise and facilitate optimal PCI completion.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What does the editorial say about PVAD versus IABP outcomes?",{"text":118,"@type":114},"Prior trials have not shown clear differences, and randomized evidence is limited. In the administrative database analysis discussed, PVAD-treated patients had lower 90-day mortality and fewer 90-day major adverse cardiac and cerebrovascular events than IABP-treated patients.",{"name":120,"@type":111,"acceptedAnswer":121},"What are the main limitations of comparing PVAD and IABP in observational data?",{"text":122,"@type":114},"Observational analyses may exclude or discount patients at the extremes of risk, cannot fully separate prophylactic versus bailout use, and remain vulnerable to unaccounted selection bias, confounding, and incomplete adjustment for inherent treatment selection.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},437170,1790763365,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":24,"preview_page_count":4},2336477405376,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","Journal of the Society for Cardiovascular Angiography & Interventions 4 (2025) 104021  \nEditorial  \nMechanical Circulatory Support for High-Risk Percutaneous Coronary Intervention: Is It a Choice or Chance That Determines Outcomes? Ali O. Malik, MD, MSc a, *, Jason R. Wollmuth, MD b  \na Department of Interventional Cardiology, Fairfield Medical Center, Lancaster, Ohio; b Department of Interventional Cardiology, Providence Heart Institute, Portland, Oregon  \nPercutaneous coronary intervention (PCI) in high-risk patients based on anatomy (left main disease, multivessel disease, calcification), comorbidities (advanced age, frailty, renal dysfunction, valvular heart disease), and adverse hemodynamics (decreased left ventricle ejection fraction, poor cardiac output, relative hypotension)1 poses a significant challenge for interventional cardiologists. Although generally well tolerated, alterations in coronary perfusion during PCI in high-risk patients can limit quality and completeness of revascularization, potentially leading to worse short-term and long-term outcomes. Use of mechanical circulatory support (MCS) devices can minimize hemodynamic compromise and enable optimal completion of PCI.2  \nIn contemporary practice, there are 2 MCS devices that are primarily used and widely available: percutaneous ventricular assist device (PVAD) and intra-aortic balloon pump (IABP) . The use of IABP in high-risk PCI has not been shown to improve patient outcomes,3 anda randomized trial comparing PVAD and IABP for high-risk PCI did not show any differences in short-term outcomes.4 This comparison, however, was not sufficiently powered to examine intermediate-term outcomes and did not account for the learning curve associated with PVAD use,5 and a per-protocol analysis did show a trend toward reduction in major adverse events at 90 days with the use of PVAD.6 Despite limited randomized trial data, IABP is still commonly used, and there has been an increase in the use of PVAD for PCI in high-risk patients in recent years.3  \nIn this issue of JSCAI, Shah et al7 ,8 present 2 articles examining the use of PVAD and IABP for high-risk PCI.7 ,8 In the research letter,8 the authors highlight limitations in comparing outcomes among patients receiving PVAD- and IABP-supported PCI using observational data. The authors highlight that in real-world use, there is no equipoise in device selection for high-risk PCI. Rather, there appears to be preferential use of PVAD for very high-risk patients and IABP for patients at a relatively lower risk. This is illustrated in the propensity score  \nmatching analysis, showing minimal overlap at the extremes of risk. As the authors point out, any observational analysis comparing outcomes between the use of PVAD and IABP electively for PCI will likely exclude or heavily discount patients at the extremes of risk. The authors also describe other challenges with observational comparison from administrative databases, such as inability to distinguish between prophylactic use and bailout; bias due to confounders, risk modifiers, and colliders; and inability to completely adjust for the inherent selection bias.  \nKeeping in mind the abovementioned limitations, the authors’leveraged data from a contemporary administrative database (2018- 2024) to compare outcomes with the use of PVAD and IABP for highrisk patients (without shock or ST-segment myocardial infarction) undergoing elective PCI.6 The strength of this analysis is a large, contemporary (2018-2024), real-world database of more than 1000 hospitals and hospital systems, not only covering approximately 25% of all inpatient hospital admissions throughout of the United States but also using a sound statistical framework and conclusions. The primary limitation of this work is inherent to all observational studies—unaccounted selection bias despite statistical adjustments used for the analysis. Moreover, with the strict inclusion and exclusion criteria, there were a significan","cbCaihclY03ghkmx","https://ap.wps.com/l/cbCaihclY03ghkmx","pdf",1668243,"English","# Editorial\n## Background and rationale for MCS in high-risk PCI\n## PVAD vs IABP: evidence and clinical practice\n## Challenges of observational comparisons\n## Summary of the featured administrative database analysis\n## Conclusions and implications","[{\"question\":\"Why is mechanical circulatory support important in high-risk PCI?\",\"answer\":\"High-risk PCI can impair coronary perfusion and limit complete revascularization, worsening short- and long-term outcomes. MCS devices may reduce hemodynamic compromise and facilitate optimal PCI completion.\"},{\"question\":\"What does the editorial say about PVAD versus IABP outcomes?\",\"answer\":\"Prior trials have not shown clear differences, and randomized evidence is limited. In the administrative database analysis discussed, PVAD-treated patients had lower 90-day mortality and fewer 90-day major adverse cardiac and cerebrovascular events than IABP-treated patients.\"},{\"question\":\"What are the main limitations of comparing PVAD and IABP in observational data?\",\"answer\":\"Observational analyses may exclude or discount patients at the extremes of risk, cannot fully separate prophylactic versus bailout use, and remain vulnerable to unaccounted selection bias, confounding, and incomplete adjustment for inherent treatment selection.\"}]","Mechanical Circulatory Support for High-Risk Percutaneous Coronary Intervention: Is It a Choice or Chance That Determines Outcomes? - Editorial | PDF",1790680491]