Acute Kidney Injury in High-Risk Percutaneous Coronary Intervention Supported by IABP Versus V-A ECMO: A Pilot Prospective Study

In this prospective pilot study, V-A ECMO support during HR-PCI was associated with more than a twofold higher rate of AKI compared with IABP, although V-A ECMO did not remain an independent predictor after adjustment. Diabetes mellitus, hemoglobin dilution, transfusion exposure, and fluid overload appear to substantially contribute to AKI risk in this population.Clinical ImpactThis prospective study highlights that V-A ECMO support during high-risk PCI is associated with a substantially higher incidence of early acute kidney injury compared with IABP, although not independently after adjustment. These findings underscore the importance of careful patient selection and individualized choice of mechanical circulatory support. For clinicians, the results emphasize the need for proactive renal protection strategies, including strict fluid balance control, minimization of transfusions, and optimization of hemoglobin levels. The study introduces a clinically relevant perspective by focusing on modifiable peri-procedural factors rather than device selection alone. Ultimately, this approach may help reduce AKI risk and improve outcomes in high-risk PCI populations.