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Updated: Jul 23, 2026
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Comparative Outcomes of Intra-Aortic Balloon Pump Versus Percutaneous Left Ventricular Assist Device in High-Risk
Dhiran Sivasubramanian1, Virushnee Senthilkumar2, Nithish Nanda Palanisamy3
1Department of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Insights
For high-risk percutaneous coronary interventions (HR-PCIs), percutaneous left ventricular assist devices (PLVADs) show lower early mortality and cardiogenic shock risk compared to intra-aortic balloon pumps (IABPs). Outcomes like bleeding and kidney injury were similar between the two mechanical circulatory support devices.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- High-risk percutaneous coronary interventions (HR-PCIs) often necessitate mechanical circulatory support (MCS) for hemodynamic stability.
- Intra-aortic balloon pumps (IABPs) and percutaneous left ventricular assist devices (PLVADs) are primary MCS options with distinct mechanisms.
- Clinical outcomes of IABP versus PLVAD in HR-PCIs without cardiogenic shock require comparative evaluation.
Purpose of the Study:
- To compare the clinical outcomes of IABP and PLVAD in patients undergoing HR-PCIs without cardiogenic shock.
- To assess differences in early mortality, major bleeding, and major adverse cardiovascular events (MACE).
- To analyze specific MACE components including cardiogenic shock, acute kidney injury (AKI), and stroke/transient ischemic attack (TIA).
Main Methods:
- Systematic review and meta-analysis of 13 studies (1 randomized controlled trial, 12 cohort studies) involving 35,554 patients.
- Inclusion criteria focused on HR-PCIs requiring MCS (IABP or PLVAD) in the absence of cardiogenic shock.
- Random-effects model with Mantel-Haenszel method used to calculate odds ratios (ORs) and 95% confidence intervals (CIs).
Main Results:
- IABP use in HR-PCIs was associated with significantly higher risks of early mortality (OR = 1.53, 95% CI [1.21, 1.94]) and cardiogenic shock (OR = 2.56, 95% CI [1.98, 3.33]) compared to PLVAD.
- No statistically significant differences were observed between IABP and PLVAD for arrhythmia, major bleeding, AKI, stroke/TIA, or hospital length of stay.
- The analysis included 30,351 patients on IABP and 5,203 patients on PLVAD.
Conclusions:
- PLVAD use in HR-PCIs is linked to reduced early mortality and a lower incidence of cardiogenic shock compared to IABP.
- The study suggests PLVAD may be a preferable MCS option in this patient population.
- No significant differences in other major adverse events indicate comparable safety profiles for certain outcomes.
Abstract:
Background/Objectives: High-risk percutaneous coronary interventions (HR-PCIs) often require mechanical circulatory support (MCS) to maintain hemodynamic stability. Intra-aortic balloon pump (IABP) and percutaneous left ventricular assist device (PLVAD) are two commonly used MCS devices that differ in their mechanisms. We aimed to evaluate and compare the clinical outcomes associated with IABP and PLVAD use in HR-PCIs without cardiogenic shock. Methods: We conducted a search of PubMed, Scopus, Cochrane, Mendeley, Web of Science, and Embase to identify relevant randomized controlled trials and cohort studies, and we included 13 studies for the systematic review and meta-analysis. The primary goal was to define the difference in early mortality (in-hospital and 30-day mortality), major bleeding, and major adverse cardiovascular event (MACE) components (cardiogenic shock, acute kidney injury (AKI), and stroke/TIA) in IABP and PLVAD. We used a random-effects model with the Mantel-Haenszel statistical method to estimate odds ratios (ORs) and 95% confidence intervals. Results: Among 1 trial and 12 cohort studies (35,554 patients; 30,351 IABP and 5203 PLVAD), HR-PCI with IABP was associated with a higher risk of early mortality (OR = 1.53, 95% CI [1.21, 1.94]) and cardiogenic shock (OR = 2.56, 95% CI [1.98, 3.33]) when compared to PLVAD. No significant differences were found in the rates of arrhythmia, major bleeding, AKI, stroke/TIA, or hospital length of stay. Conclusions: In high-risk PCIs, PLVAD use is associated with lower early mortality and cardiogenic shock risk compared to IABP, with no significant differences in other major outcomes.
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