Safety and efficacy of mechanical circulatory support with Impella or intra-aortic balloon pump for high-risk percutaneous coronary intervention and/or cardiogenic shock: Insights from a network meta-analysis of randomized trials.

Abstract

BACKGROUND:

Mechanical circulatory support (MCS) with Impella or intra-aortic balloon pump (IABP) is used for high-risk percutaneous coronary intervention (PCI) and/or for cardiogenic shock (CS) due to acute myocardial infarction. We aimed to investigate the efficacy and safety of Impella or IABP when compared with no MCS using a network meta-analysis of randomized controlled trials (RCTs).

METHODS:

EMBASE and MEDLINE were searched through February 2020 for RCT evaluating efficacy of Impella vs. IABP vs. no MCS in patients undergoing high-risk PCI or CS. The primary efficacy outcome was 30 day or in-hospital all-cause mortality whereas the primary safety outcomes were major bleeding and vascular complications.

RESULTS:

Our search identified nine RCTs enrolling a total of 1,996 patients with high-risk PCI and/or CS. There was no significant difference with Impella or IABP on all-cause mortality when compared with no MCS (Impella vs. no MCS; OR:0.82 [0.35-1.90], p = .65, IABP vs. no MCS; OR:0.77 [0.47-1.28], p = .31, I2 = 18.1%). Impella significantly increased major bleeding compared with no MCS (Impella vs. no MCS; OR:7.01 [1.11-44.4], p = .038, I2 = 19.2%). IABP did not increase the risk of major bleeding compared with no MCS (OR:1.27 [0.75-2.16], p = .38, I2 = 19.2%) but increased vascular complication compared with no MCS (OR:1.92 [1.01-3.64], p = .045, I2 = 1.5%).

CONCLUSIONS:

Neither Impella nor IABP decreased all-cause short-term mortality when compared with no MCS for high-risk PCI and/or CS. Moreover, Impella increased major bleeding compared with no MCS.

• Authors: Toshiki Kuno, Hisato Takagi, Tomo Ando, Masaki Kodaira, Yohei Numasawa, John Fox, Sripal Bangalore
• Journal: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions (Catheter Cardiovasc Interv) Vol. 97 Issue 5 Pg. E636-E645 (04 01 2021) ISSN: 1522-726X [Electronic] United States
• PMID: 32894797 (Publication Type: Journal Article, Meta-Analysis)
• Copyright: © 2021 Wiley Periodicals LLC.

Topics

• Heart-Assist Devices (adverse effects)
• Humans
• Intra-Aortic Balloon Pumping (adverse effects)
• Network Meta-Analysis
• Percutaneous Coronary Intervention (adverse effects)
• Randomized Controlled Trials as Topic
• Shock, Cardiogenic (diagnosis, etiology, therapy)
• Treatment Outcome