Lower AKI Risk and Higher Survival With Microaxial Flow Pump Support During Elective PCI: A Propensity Score-Matched Study

Background: Acute kidney injury (AKI) is associated with worse outcomes after percutaneous coronary intervention (PCI). Previous, smaller studies suggested nephroprotective effects of micro-axial flow pump (mAFP) during PCI. This study aimed to compare renal outcomes of high-risk PCI with mAFP or intraaortic balloon pump (IABP) support. Aims: This study aimed to compare renal outcomes of high-risk PCI with mAFP or intraaortic balloon pump (IABP) support. Methods: Patients undergoing elective, non-emergent, high-risk PCI with mAFP or IABP between 2017 and 2025 were retrospectively included from the TRUVETA database, which covers 120 million US patients. Patients with mAFP or IABP support were propensity score-matched for AKI risk, adjusting for demographic and clinical characteristics including baseline kidney function, AKI risk, and comorbidities. Results: Of 24,645 patients undergoing PCI with mechanical circulatory support, 7872 elective high-risk PCI cases were identified: 2349 (29.8%) with IABP and 5523 (70.2%) with mAFP support. Prior to matching, patients receiving mAFP support were older and had more comorbidities compared to IABP. After exclusion of patients with missing baseline eGFR, propensity score matching was performed in 4666 patients (2333 per group) resulting in comparable baseline characteristics of the two groups. After matching, the risk of AKI (18.9% vs. 23.2%) and all-cause mortality (15.9% vs. 20.7%) was lower in mAFP-supported patients compared to IABP (all p < 0.001). Bleeding, stroke, and RRT incidences were comparable between groups. There was no interaction between baseline kidney function and lower AKI risk with mAFP. Conclusion: This propensity score-matched observational study indicates that the use of mAFP in the setting of elective high-risk PCI is associated with a lower risk of AKI and higher survival compared with IABP.