Key Points<\/p>\n\n\n\n
Complex PCI in patients with severe left ventricular dysfunction remains at high risk, and mechanical circulatory support has been increasingly adopted despite limited randomized evidence. The CHIP-BCIS3 trial (NCT5003817<\/a>), presented at ACC.26 and simultaneously published in the New England Journal of Medicine<\/a>, evaluated whether elective left ventricular unloading with a microaxial flow pump improves outcomes in this population.<\/p>\n\n\n\n This prospective, multicenter, randomized trial enrolled 300 patients with severe LV dysfunction (median LVEF ~27%) and extensive coronary artery disease undergoing complex PCI. Patients were randomized 1:1 to microaxial flow pump support (n=148) versus standard care without planned mechanical support (n=152). The primary endpoint was a hierarchical composite of death, disabling stroke, spontaneous MI, cardiovascular hospitalization, or periprocedural myocardial injury, analyzed using a win-ratio approach.<\/p>\n\n\n\n At a median follow-up of 22 months, the primary outcome showed no benefit with the microaxial flow pump strategy: 36.6% of pairwise comparisons favored the device versus 43.0% favoring standard care (win ratio 0.85; 95% CI, 0.63\u20131.15; p=0.30), corresponding to an absolute difference of \u22126.4 percentage points. Sensitivity analyses were consistent, with no difference in time-to-first-event composite outcomes (HR 1.06; 95% CI, 0.75\u20131.49 when excluding periprocedural MI).<\/p>\n\n\n\n Notably, mortality signals favored standard care. Death from any cause occurred in 32.6% of patients in the microaxial flow pump group versus 23.4% in the standard-care group (HR 1.54; 95% CI, 0.99\u20132.41). Cardiovascular death was significantly higher with device use (26.7% vs. 14.5%; HR 1.91; 95% CI, 1.11\u20133.30). There were no significant differences in other ischemic outcomes: spontaneous MI (HR 0.64; 95% CI, 0.28\u20131.47), cardiovascular hospitalization (HR 1.20; 95% CI, 0.72\u20131.98), or disabling stroke (HR 0.53; 95% CI, 0.13\u20132.11). Periprocedural myocardial injury was numerically higher with the device (61.7% vs. 50.0%; risk ratio 1.23; 95% CI, 0.99\u20131.54).<\/p>\n\n\n\n Importantly, procedural goals were not improved by mechanical support. Completeness of revascularization was similar between groups (median coronary revascularization index ~67%), undermining the hypothesis that hemodynamic support enables more complete PCI. Safety outcomes showed no statistically significant differences in major bleeding (10.8% vs. 7.3%; RR 1.48; 95% CI, 0.71\u20133.09) or major vascular complications. Overall, CHIP-BCIS3 provides the first randomized evidence directly comparing elective microaxial flow pump use versus no planned support in high-risk PCI\u2014and does not support routine upfront use of these devices in stable patients with severe LV dysfunction. Dr. Divaka Perera, the study\u2019s senior author, stated: \u201cUsing a microaxial flow pump upfront and electively does not appear to reduce the rates of major adverse events, and this signal of excess deaths, in particularly, cardiovascular deaths requires further investigation.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":" Key Points Complex PCI in patients with severe left ventricular dysfunction remains at high risk, and mechanical circulatory support has been increasingly adopted despite limited randomized evidence. The CHIP-BCIS3 trial (NCT5003817), presented at ACC.26 and simultaneously published in the New England Journal of Medicine, evaluated whether elective left ventricular unloading with a microaxial flow pump […]<\/p>\n","protected":false},"author":40616,"featured_media":139725,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"aside","meta":{"footnotes":""},"categories":[1074,8],"tags":[1075,45,47,185],"ppma_author":[1070],"class_list":{"0":"post-139724","1":"post","2":"type-post","3":"status-publish","4":"format-aside","5":"has-post-thumbnail","7":"category-acc-2026","8":"category-news","9":"tag-acc-2026","10":"tag-conference","11":"tag-featured","12":"tag-news","13":"post_format-post-format-aside","14":"author-joseph-kim-md"},"authors":[{"term_id":1070,"user_id":40616,"is_guest":0,"slug":"joseph-kim-md","display_name":"Joseph Kim MD","avatar_url":"https:\/\/secure.gravatar.com\/avatar\/bf0879bf0ca450025acf71d7345cf24be4748f67f7b0c6423d186a5765c5cda9?s=96&r=g","0":null,"1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":""}],"_links":{"self":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/139724","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/users\/40616"}],"replies":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=139724"}],"version-history":[{"count":1,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/139724\/revisions"}],"predecessor-version":[{"id":139726,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/139724\/revisions\/139726"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/media\/139725"}],"wp:attachment":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=139724"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=139724"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=139724"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fppma_author&post=139724"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}