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Published on: June 12, 2021
Comparative Effectiveness of Mechanical Circulatory Support Devices in Patients Undergoing Complex High-Risk
Haonan Xu1, Wenxin Guo1, Oscar Hou In Chou2,3
1Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China.
Background:
Patients undergoing complex high-risk percutaneous coronary interventions (CHIP) are prone to hemodynamic instability, and the optimal mechanical circulatory support (MCS) strategy for this population remains unclear.
Aims:
This systematic review and network meta-analysis aimed to compare the short-term safety and efficacy of various MCS strategies in CHIP.
Methods:
We systematically searched PubMed, Web of Science, Embase, and the Cochrane Library for studies comparing different MCS strategies in CHIP patients with short-term endpoints. The primary efficacy outcome was in-hospital or 30-day mortality. Safety outcomes included MCS-related complications, specifically bleeding and stroke. The MCS strategies evaluated were intra-aortic balloon pump (IABP), veno-arterial extracorporeal membrane oxygenation (VA-ECMO), IMPELLA, VA-ECMO + IABP, and VA-ECMO + IMPELLA (ECPELLA). A random-effects Bayesian network meta-analysis was performed, integrating both direct and indirect comparisons.
Results:
Twelve studies involving a total of 75,274 patients were included. Both IABP (OR: 0.33; 95% CI: 0.13-0.91) and IMPELLA (OR: 0.44; 95% CI: 0.21-0.96) were associated with significantly lower short-term mortality compared to VA-ECMO. No significant differences were observed among other strategies. Rank probability analysis suggested that IABP had the highest probability of being the most effective strategy for reducing short-term mortality. Regarding safety outcomes, IABP was associated with a significantly lower bleeding risk compared to VA-ECMO (OR: 0.18; 95% CI: 0.04-0.82), VA-ECMO + IABP (OR: 0.18; 95% CI: 0.03-0.87), ECPELLA (OR: 0.12; 95% CI: 0.02-0.70), and IMPELLA (OR: 0.21; 95% CI: 0.05-0.75), with no significant difference in stroke risk across strategies.
Conclusions:
Among available MCS strategies for CHIP patients, IABP appears to be associated with improved short-term survival and a lower risk of bleeding, without an increased risk of stroke. These findings support IABP as a potentially preferable support option, warranting further validation in prospective clinical trials.
