Microaxial circulatory support for percutaneous coronary intervention: A systematic review and meta-analysis
Sophie A. Leon
Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
Search for more papers by this authorJake L. Rosen
Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
Search for more papers by this authorDanial Ahmad
Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
Search for more papers by this authorMelissa A. Austin
Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
Search for more papers by this authorAlec Vishnevsky
Division of Cardiology, Department of Medicine, Thomas Jefferson University, Pennsylvania, Philadelphia, USA
Search for more papers by this authorIndranee N. Rajapreyar
Division of Cardiology, Department of Medicine, Thomas Jefferson University, Pennsylvania, Philadelphia, USA
Search for more papers by this authorNicholas J. Ruggiero
Division of Cardiology, Department of Medicine, Thomas Jefferson University, Pennsylvania, Philadelphia, USA
Search for more papers by this authorJ. Eduardo Rame
Division of Cardiology, Department of Medicine, Thomas Jefferson University, Pennsylvania, Philadelphia, USA
Search for more papers by this authorJohn W. Entwistle
Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
Search for more papers by this authorHoward T. Massey
Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
Search for more papers by this authorCorresponding Author
Vakhtang Tchantchaleishvili
Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
Correspondence
Vakhtang Tchantchaleishvili, Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, 1025 Walnut Street, Suite 607, Philadelphia, PA 19107, USA.
Email: [email protected]
Search for more papers by this authorSophie A. Leon
Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
Search for more papers by this authorJake L. Rosen
Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
Search for more papers by this authorDanial Ahmad
Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
Search for more papers by this authorMelissa A. Austin
Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
Search for more papers by this authorAlec Vishnevsky
Division of Cardiology, Department of Medicine, Thomas Jefferson University, Pennsylvania, Philadelphia, USA
Search for more papers by this authorIndranee N. Rajapreyar
Division of Cardiology, Department of Medicine, Thomas Jefferson University, Pennsylvania, Philadelphia, USA
Search for more papers by this authorNicholas J. Ruggiero
Division of Cardiology, Department of Medicine, Thomas Jefferson University, Pennsylvania, Philadelphia, USA
Search for more papers by this authorJ. Eduardo Rame
Division of Cardiology, Department of Medicine, Thomas Jefferson University, Pennsylvania, Philadelphia, USA
Search for more papers by this authorJohn W. Entwistle
Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
Search for more papers by this authorHoward T. Massey
Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
Search for more papers by this authorCorresponding Author
Vakhtang Tchantchaleishvili
Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
Correspondence
Vakhtang Tchantchaleishvili, Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, 1025 Walnut Street, Suite 607, Philadelphia, PA 19107, USA.
Email: [email protected]
Search for more papers by this authorAbstract
Background
Microaxial circulatory support devices have been used to support patients treated with percutaneous coronary intervention (PCI) for acute myocardial infarction complicated by cardiogenic shock (AMICS). The purpose of this systematic review and meta-analysis was to pool and analyze the existing evidence on the baseline characteristics, periprocedural data, and outcomes of microaxial support before and after PCI in AMICS.
Methods
An electronic database search was performed to identify all cohort studies on Impella and PCI for cardiogenic shock in the English language. A total of five articles comprising 543 patients were included. These patients received microaxial support either before (pre-PCI) or after (post-PCI) undergoing PCI. Comparative analyses were done between both groups.
Results
The mean patient age was 66 years [95% Confidence Interval (58–74)], and 22% (89/396) of patients were female. ST-elevation myocardial infarctions (MI) comprised 64% (44–80) of MIs and 50% (44–56) of MIs involved the left anterior descending artery. The mean number of diseased vessels was 2.21 (1.62–2.80). The mean left ventricular ejection fraction was 31% (23.4–38.6). The mean arterial pressure was 66.3 mm Hg (54.1–78.5). Mean serum lactate [6.1 mmol/L (3.3–8.9)] and serum creatinine [1.4 mg/dl (1.0–1.7)] were similar between groups. 30-day mortality was lower in the pre-PCI group [41% (34%–49%)] compared to the post-PCI group [61% (42%–77%), p < 0.01]. Pooled Kaplan–Meier analysis showed better early survival in the pre-PCI group (p < 0.001).
Conclusion
Patients presenting with AMICS were similar at baseline in both pre-PCI and post-PCI groups. Nevertheless, pre-PCI group showed better early survival compared to post-PCI group.
CONFLICT OF INTEREST
The authors declare that they have no conflicts of interest with the contents of this article.
REFERENCES
- 1Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, et al. Heart disease and stroke statistics—2022 update: a report from the American Heart Association. Circulation. 2022; 145(8): e153–639.
- 2Kosaraju A, Pendela VS, Hai O. Cardiogenic shock. Treasure Island, FL: StatPearls Publishing LLC; 2022.
- 3Kimman JR, Van Mieghem NM, Endeman H, Brugts JJ, Constantinescu AA, Manintveld OC, et al. Mechanical support in early cardiogenic shock: what is the role of intra-aortic balloon counterpulsation? Curr Heart Fail Rep. 2020; 17(5): 247–60.
- 4O'Neill WW, Grines C, Schreiber T, Moses J, Maini B, Dixon SR, et al. Analysis of outcomes for 15 259 US patients with acute myocardial infarction cardiogenic shock (AMICS) supported with the Impella device. Am Heart J. 2018; 202: 33–8.
- 5Stretch R, Sauer CM, Yuh DD, Bonde P. National trends in the utilization of short-term mechanical circulatory support. J Am Coll Cardiol. 2014; 64(14): 1407–15.
- 6Basir MB, Schreiber TL, Grines CL, Dixon SR, Moses JW, Maini BS, et al. Effect of early initiation of mechanical circulatory support on survival in cardiogenic shock. Am J Cardiol. 2017; 119(6): 845–51.
- 7Thiele H, Zeymer U, Neumann F-J, Ferenc M, Olbrich H-G, Hausleiter J, et al. Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med. 2012; 367(14): 1287–96.
- 8Unverzagt S, Buerke M, de Waha A, Haerting J, Pietzner D, Seyfarth M, et al. Intra-aortic balloon pump counterpulsation (IABP) for myocardial infarction complicated by cardiogenic shock. Cochrane Database Syst Rev. 2015; 3:CD007398.
- 9Zeymer U, Hochadel M, Hauptmann K-E, Wiegand K, Schuhmacher B, Brachmann J, et al. Intra-aortic balloon pump in patients with acute myocardial infarction complicated by cardiogenic shock: results of the ALKK-PCI registry. Clin Res Cardiol. 2013; 102(3): 223–7.
- 10Thiele H, Zeymer U, Thelemann N, Neumann F-J, Hausleiter J, Abdel-Wahab M, et al. Intraaortic balloon pump in cardiogenic shock complicating acute myocardial infarction. Circulation. 2019; 139(3): 395–403.
- 11Miller PE, Bromfield SG, Ma Q, Crawford G, Whitney J, DeVries A, et al. Clinical outcomes and cost associated with an intravascular microaxial left ventricular assist device vs intra-aortic balloon pump in patients presenting with acute myocardial infarction complicated by cardiogenic shock. JAMA Intern Med. 2022; 182(9): 926–33.
- 12Dhruva SS, Ross JS, Mortazavi BJ, Hurley NC, Krumholz HM, Curtis JP, et al. Use of mechanical circulatory support devices among patients with acute myocardial infarction complicated by cardiogenic shock. JAMA Netw Open. 2021; 4(2):e2037748.
- 13O'Neill WW, Anderson M, Burkhoff D, Grines CL, Kapur NK, Lansky AJ, et al. Improved outcomes in patients with severely depressed LVEF undergoing percutaneous coronary intervention with contemporary practices. Am Heart J. 2022; 248: 139–49.
- 14O'Neill WW, Kleiman NS, Moses J, Henriques JP, Dixon S, Massaro J, et al. A prospective, randomized clinical trial of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention: the PROTECT II study. Circulation. 2012; 126(14): 1717–27.
- 15Joseph SM, Brisco MA, Colvin M, Grady KL, Walsh MN, Cook JL, et al. Women with cardiogenic shock derive greater benefit from early mechanical circulatory support: an update from the cVAD registry. J Interv Cardiol. 2016; 29(3): 248–56.
- 16Meraj PM, Doshi R, Schreiber T, Maini B, O'Neill WW. Impella 2.5 initiated prior to unprotected left main PCI in acute myocardial infarction complicated by cardiogenic shock improves early survival. J Interv Cardiol. 2017; 30(3): 256–63.
- 17Schäfer A, Werner N, Burkhoff D, Sieweke J-T, Zietzer A, Masyuk M, et al. Influence of timing and predicted risk on mortality in Impella-treated infarct-related cardiogenic shock patients. Front Cardiovasc Med. 2020; 7:74.
- 18Lazkani M, Murarka S, Kobayashi A, Seibolt L, Yang T, Pershad A. A retrospective analysis of Impella use in all-comers: 1-year outcomes. J Interv Cardiol. 2017; 30(6): 577–83.
- 19Loehn T, O'Neill WW, Lange B, Pfluecke C, Schweigler T, Mierke J, et al. Long term survival after early unloading with Impella CP® in acute myocardial infarction complicated by cardiogenic shock. Eur Heart J Acute Cardiovasc Care. 2020; 9(2): 149–57.
- 20Tarantini G, Masiero G, Burzotta F, Pazzanese V, Briguori C, Trani C, et al. Timing of Impella implantation and outcomes in cardiogenic shock or high-risk percutaneous coronary revascularization. Catheter Cardiovasc Interv. 2021; 98(2): E222–34.
- 21Chatzis G, Markus B, Luesebrink U, Ahrens H, Divchev D, Syntila S, et al. Early Impella support in postcardiac arrest cardiogenic shock complicating acute myocardial infarction improves short- and long-term survival. Crit Care Med. 2021; 49(6): 943–55.
- 22Hemradj VV, Karami M, Sjauw KD, Engström AE, Ouweneel DM, de Brabander J, et al. Pre-PCI versus immediate post-PCI Impella initiation in acute myocardial infarction complicated by cardiogenic shock. PLoS ONE. 2020; 15(7):e0235762.
- 23O'Neill WW, Schreiber T, DHW W, Rihal C, Naidu SS, Civitello AB, et al. The current use of Impella 2.5 in acute myocardial infarction complicated by cardiogenic shock: results from the USpella registry. J Interv Cardiol. 2014; 27(1): 1–11.
- 24Kwon D, Reis IM. Simulation-based estimation of mean and standard deviation for meta-analysis via approximate Bayesian computation (ABC). BMC Med Res Methodol. 2015; 15: 61.
- 25Guyot P, Ades AE, Ouwens MJ, Welton NJ. Enhanced secondary analysis of survival data: reconstructing the data from published Kaplan-Meier survival curves. BMC Med Res Methodol. 2012; 12: 9.
- 26Menees DS, Peterson ED, Wang Y, Curtis JP, Messenger JC, Rumsfeld JS, et al. Door-to-balloon time and mortality among patients undergoing primary PCI. N Engl J Med. 2013; 369(10): 901–9.
- 27Kapur NK, Davila CD. Timing, timing, timing: the emerging concept of the ‘door to support’ time for cardiogenic shock. Eur Heart J. 2017; 38(47): 3532–4.
- 28Fuernau G, Ledwoch J, Desch S, Eitel I, Thelemann N, Jung C, et al. Impact of timing of intraaortic balloon counterpulsation on mortality in cardiogenic shock—a subanalysis of the IABP-SHOCK II trial. Eur Heart J Acute Cardiovasc Care. 2020; 10(1): 54–61.
- 29Cheng JM, van Leeuwen MAH, de Boer SPM, Wai MCGTJ, den Uil CA, Jewbali LSD, et al. Impact of intra-aortic balloon pump support initiated before versus after primary percutaneous coronary intervention in patients with cardiogenic shock from acute myocardial infarction. Int J Cardiol. 2013; 168(4): 3758–63.
- 30Sjauw KD, Engström AE, Vis MM, Boom W, Baan J, de Winter RJ, et al. Efficacy and timing of intra-aortic counterpulsation in patients with ST-elevation myocardial infarction complicated by cardiogenic shock. Neth Heart J. 2012; 20(10): 402–9.
- 31Helgestad OKL, Josiassen J, Hassager C, Jensen LO, Holmvang L, Udesen NLJ, et al. Contemporary trends in use of mechanical circulatory support in patients with acute MI and cardiogenic shock. Open Heart. 2020; 7(1):e001214.
- 32Abdel-Wahab M, Saad M, Kynast J, Geist V, Sherif MA, Richardt G, et al. Comparison of hospital mortality with intra-aortic balloon counterpulsation insertion before versus after primary percutaneous coronary intervention for cardiogenic shock complicating acute myocardial infarction. Am J Cardiol. 2010; 105(7): 967–71.
- 33Dhruva SS, Ross JS, Mortazavi BJ, Hurley NC, Krumholz HM, Curtis JP, et al. Association of use of an intravascular microaxial left ventricular assist device vs intra-aortic balloon pump with in-hospital mortality and major bleeding among patients with acute myocardial infarction complicated by cardiogenic shock. JAMA. 2020; 323(8): 734–45.
- 34Manian N, Thakker J, Nair A. The use of mechanical circulatory assist devices for ACS patients with cardiogenic shock and high-risk PCI. Curr Cardiol Rep. 2022; 24(6): 699–709.
- 35Tehrani BN, Truesdell AG, Sherwood MW, Desai S, Tran HA, Epps KC, et al. Standardized team-based care for cardiogenic shock. J Am Coll Cardiol. 2019; 73(13): 1659–69.
- 36Seyfarth M, Sibbing D, Bauer I, Fröhlich G, Bott-Flügel L, Byrne R, et al. A randomized clinical trial to evaluate the safety and efficacy of a percutaneous left ventricular assist device versus intra-aortic balloon pumping for treatment of cardiogenic shock caused by myocardial infarction. J Am Coll Cardiol. 2008; 52(19): 1584–8.
- 37Vargas KG, Jäger B, Kaufmann CC, Biagioli A, Watremez S, Gatto F, et al. Impella in cardiogenic shock following acute myocardial infarction: a systematic review and meta-analysis. Wien Klin Wochenschr. 2020; 132(23): 716–25.
- 38Amin AP, Spertus JA, Curtis JP, Desai N, Masoudi FA, Bach RG, et al. The evolving landscape of Impella use in the United States among patients undergoing percutaneous coronary intervention with mechanical circulatory support. Circulation. 2020; 141(4): 273–84.
