PREPROCEDURAL vascular sheath insertion significantly reduced in-hospital mortality among high-risk patients undergoing percutaneous coronary intervention (PCI), according to new multicentre data.
The Risks of PCI
High-risk PCI patients are particularly vulnerable to complications such as ischaemia–reperfusion injury, haemodynamic collapse, and cardiogenic shock. Although mechanical circulatory support (MCS) can be lifesaving in these scenarios, its routine prophylactic use has been limited by cost and device-related complications. Identifying strategies that allow rapid mechanical circulatory support deployment without routine prophylactic MCS device implantation has therefore become a priority in interventional cardiology.
In this retrospective analysis of 443 high-risk PCI patients, researchers evaluated whether preprocedural vascular sheath insertion could improve outcomes. The technique involves pre-emptively inserting femoral arteriovenous sheaths before PCI, enabling faster initiation of MCS if haemodynamic deterioration occurs.
Preprocedural Vascular Sheath Insertion Improved Survival
After propensity score matching, 110 matched pairs were analysed. Preprocedural vascular sheath insertion was associated with significantly lower all-cause in-hospital mortality compared with standard care (odds ratio: 0.21; 95% CI: 0.08–0.59; p=0.003). Mortality occurred in 4.5% of patients in the sheath group versus 18.2% in the non-sheath group.
Neurological outcomes also favoured preprocedural vascular sheath insertion. Poor neurological outcomes were reported in 9.1% of patients in the sheath group compared with 19.1% in controls (odds ratio: 0.42; 95% CI: 0.19–0.96; p=0.037). Importantly, there were no significant differences in the incidence of cardiogenic shock, overall MCS use, or vascular complications between groups.
The Future of PCI Treatment
PCI remains one of the most commonly performed coronary revascularisation procedures worldwide. Therefore, strategies that enhance safety in high-risk PCI are of broad clinical relevance.
The study was retrospective and observational in design, introducing potential residual confounding despite matching. The sample size after matching was also modest, and prospective randomised trials will be required to confirm causality.
Nevertheless, these findings suggested that routine preprocedural vascular sheath insertion may offer a pragmatic, low-risk approach to improving survival and neurological outcomes in high-risk PCI without increasing procedural complications. Further validation could support its broader implementation in contemporary practice.
Reference
Sun B et al. Preprocedural vascular sheath insertion reduces hospital mortality in high risk PCI patients. Sci Rep. 2026; DOI:10.1038/s41598-026-36613-z.
