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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock

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Percutaneous assist devices in acute myocardial infarction with cardiogenic shock: Review, meta-analysis

Francesco Romeo1, Maria Cristina Acconcia1, Domenico Sergi1

  • 1Francesco Romeo, Domenico Sergi, Alessia Romeo, Department of Cardiovascular Disease, University of Rome - Tor Vergata, 00133 Rome, Italy.

World Journal of Cardiology
|February 4, 2016
PubMed

Insights

Intra-aortic balloon pump (IABP) use in cardiogenic shock (CS) after myocardial infarction (MI) increased in-hospital mortality. Extracorporeal membrane oxygenation (ECMO) with IABP significantly reduced mortality compared to IABP alone.

Area of Science:

  • Cardiology
  • Intensive Care Medicine
  • Mechanical Circulatory Support

Background:

  • Cardiogenic shock (CS) complicating acute myocardial infarction (AMI) has a high mortality rate.
  • Percutaneous cardiac support devices are used to improve outcomes in these patients.
  • The comparative effectiveness of different support strategies remains an area of active research.

Purpose of the Study:

  • To evaluate the impact of percutaneous cardiac support devices on in-hospital and late mortality in patients with CS due to AMI undergoing percutaneous coronary intervention.
  • To compare intra-aortic balloon pump (IABP), percutaneous left ventricular assist devices (PLVADs), and extracorporeal membrane oxygenation (ECMO) in this patient population.

Main Methods:

  • A systematic review and meta-analysis of studies published between 1997 and 2015.
  • Included studies compared IABP vs. medical therapy, PLVADs vs. IABP, ECMO + IABP vs. IABP alone, and ECMO + IABP vs. ECMO alone.
  • Primary endpoint was in-hospital mortality; secondary endpoint was late mortality at 6-12 months.

Main Results:

  • Thirty studies involving 15,799 patients were included.
  • In-hospital mortality was significantly higher with IABP compared to medical therapy (RR = +15%, P = 0.0002).
  • ECMO plus IABP significantly reduced in-hospital mortality compared to IABP alone (RR = -44%, P = 0.0008) and ECMO alone (RR = -20%, P = 0.006).
  • PLVADs did not significantly reduce early mortality compared to IABP (RR = +14%, P = 0.21).

Conclusions:

  • Intra-aortic balloon pump (IABP) therapy is associated with increased in-hospital mortality in patients with acute myocardial infarction and cardiogenic shock.
  • Percutaneous left ventricular assist devices (PLVADs) did not demonstrate a significant reduction in early mortality.
  • Extracorporeal membrane oxygenation (ECMO) in conjunction with IABP offers a significant survival benefit compared to IABP or ECMO alone in this high-risk group.
Abstract

Keywords:
Cardiogenic shockExtracorporeal membrane oxygenationImpellaIntra-aortic balloon pumpMeta-analysisTandemHeart

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