NyokAssist™ VAD vs. ECMO in high-risk PCI

Inclusion Criteria:

1\. Age eligible (18 ≤ Age ≤ 90). 2. Subject is indicated for a non-emergent percutaneous treatment of at least one de novo or restenotic lesion in a native coronary vessel or bypass graft .

3\. The subjects' left ventricular ejection fraction (LVEF) and imaging results met both of the following a and b :

1. LVEF ≤ 35%; or LVEF ≤ 40% with NYHA functional class ≥ III.
2. Imaging criteria:

   Chronic total occlusion (CTO) in at least two vessels; or No unprotected left main coronary artery lesion; or Three-vessel disease.

   \*Three-vessel disease was defined as the presence at least one sign ficant stenosis ≥ 50% in the left anterior descending artery (LAD) and/or side branch, left circumflex artery (LCX) and/or side branch, and right coronary artery (RCA) and/or side branch. In the case of left coronary artery dominance, a lesion ≥ 50% in the proximal LAD and the LCX qualified as three-vessel disease.

   5.Volunteered to participate and Signed Informed Consent and able to cooperate with the whole trial process.

   Exclusion Criteria:

   1.Acute ST elevation Myocardial Infarction within 24 hours or CK-MB that have not normalized after acute ST elevation Myocardial Infarction.

   2.Pre-procedure cardiac arrest within 24 hours of enrollment requiring CPR. 3.Subject is in cardiogenic shock defined as:
   * CI \< 2.2 L/min/m2 and PCWP \> 15 mmH
   * Hypotension (systolic BP \< 90 mmHg for \>30 minutes or the need for supportive measures to maintain a systolic BP of greater than or equal to 90 mmHg) AND end organ hypoperfusion (cool extremities OR \[a urine output of \< 30 mL/hour AND a HR \> 60 BPM\]) 4.Mural thrombus in the left ventricle. 5.The presence of aortic valve replacement or mechanical circulatory support device. 6.Subject has mechanical complications of myocardial infarction.

     7.Documented presence of severe aortic stenosis. aortic valve area (AVA) ≤ 1.0 cm².

     8.Documented presence of moderate to severe mitral stenosis. 9.Documented presence of moderate to severe aortic insufficiency. 10.Severe peripheral arterial obstructive disease that would preclude device placement.

     11.Abnormalities of the aorta that would preclude surgery, including aortic aneurysms,aortic dissection and extreme tortuosity or calcifications.

     12.Subject with renal failure (creatinine ≥265μmol/L) . 13.Subject with liver dysfunction ( liver enzymes and bilirubin levels ≥3x URL or INR≥2 ).

     14.Subject has uncorrectable abnormal coagulation parameters (platelet count ≤ 75╳109 /L or fibrinogen ≤ 1.50 g/L or INR≥2) .

     15.History of recent (within 1 month) stroke or TIA . 16.Severe right ventricular dysfunction,such as severe pulmonary hypertension. 17.Allergy or intolerance to heparin, aspirin, ADP receptor inhibitors or contrast media.

     18.Subject with documented heparin induced thrombocytopenia. 19.Atrial or ventricular septal defect (including post-infarction ventricular septal rupture).

     20.Subject has pregnant or lactating. 21.Participation in the active follow-up phase of another clinical study of an investigational drug or device within 1 month.

     22.Investigators consider unsuitable to participate in the trial.