心臓発作による急性心筋梗塞に対するインペラサポート
Benedikt Schrage1, Karim Ibrahim2, Tobias Loehn2
1University Heart Centre Hamburg, Department of General and Interventional Cardiology, Germany (B.S., R.T., S.B., D.W.).
Circulation
|December 28, 2018
まとめ
インペラ装置は,心臓発作による急性心筋梗塞 (AMI- CS) 患者の30日間の死亡率を,大動脈内気球ポンプ (IABP) または医療療法と比較して減少させなかった. Impellaの使用で出血の増加と血管合併症が観察されました.
科学分野:
- 心臓病科
- 介入心臓科
- メカニカル・サーキュレーション・サポート
背景:
- 心臓発作による急性心筋梗塞 (AMI-CS) の治療には,皮膚経由の機械循環補助器具 (MCS) がますます使用されています.
- インペラのような装置の有効性を裏付ける証拠は限られている.
- この研究では,インペラの使用と,大動脈内気球ポンプ (IABP) とAMI- CS患者での治療の結果を比較した.
研究 の 目的:
- AMI-CS患者におけるインペラ装置の使用の結果を評価する.
- この患者集団におけるIABPに対するImpellaの効果と治療の効果を比較する.
- インペラで治療されたAMI- CS患者の30日間の全因死亡率を評価する.
主な方法:
- インペラで治療されたAMI- CS患者の欧州の医療機関からの遡及データ収集.
- IABP- SHOCK II試験の237人の患者と,重要な臨床パラメータを基にマッチングした.
- 主なエンドポイントは,出血と血管合併症の二次評価による30日間の全原因死亡率でした.
主要な成果:
- Impella群 (48. 5%) とIABP群 (46. 4%) の間で30日間の全因死亡率に有意な差はなかった.
- インペラの使用は,重度または生命を脅かす出血 (8. 5% 対 3. 0%) と外周血管合併症 (9. 8% 対 3. 8%) の有意な増加と関連していました.
- IABPを対照群として受けた患者だけに分析した結果も一貫した.
結論:
- この遡及的分析では,インペラ装置は,IABPまたは医療療法と比較して,AMI- CS患者の30日間の死亡率の減少を示さなかった.
- 研究では,Impellaの使用で出血や血管合併症の危険性が高まっていることが示されています.
- AMI- CS患者のアウトカムに対するImpellaデバイスの効果を決定するために大規模なランダム化試験が必要である.
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