Hemodynamic Effects Of Impella On Renal Circulation And Risk Of CA-AKI Among Patients Undergoing Protected PCI

Inclusion Criteria: Impella-protected PCI selection criteria according to Virginia Commonwealth University (VCU) Complex PCI Program * Left ventricular ejection fraction (LVEF) ≤35% and ≥1 complexity feature * LVEF ≤45% and estimated glomerular filtration rate (eGFR) \<30 ml/min/1.73 m2 and ≥1 complexity feature * LVEF ≤45% and eGFR 31-45 ml/min/1.73 m2 and ≥2 complexity features Complexity features * Planned treatment of ≥2 vessels * Left main PCI * Bifurcation intervention with 2-stent strategy * Planned use of atherectomy (rotational, orbital, laser) * Chronic total occlusion PCI * PCI on last remaining vessel * LVEDP \>18 mmHg * Cardiac index \<2.0 l/min/m2 or pulmonary artery O2 saturation \<55% Exclusion Criteria:- * Pregnancy or lactation * Presence of non-MRI compatible implanted medical device * Known absolute contraindication to Impella insertion, e.g. severe peripheral arterial disease, left ventricular thrombus, aortic mechanical prosthesis, or severe aortic valve stenosis * Chronic hemodialysis before the index procedure * Status post-renal transplant * Prisoners