Safety and efficacy of mechanical circulatory support with Impella or intra-aortic balloon pump for high-risk percutaneous coronary intervention and/or cardiogenic shock: Insights from a network meta-analysis of randomized trials
Corresponding Author
Toshiki Kuno MD, PhD, FESC, FSCAI
Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York
Correspondence
Toshiki Kuno MD, PhD, FESC, FSCAI, Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, First Avenue, 16th street, New York, NY 10003.
Email: [email protected]
Search for more papers by this authorHisato Takagi MD, PhD
Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
Search for more papers by this authorTomo Ando MD
Division of Cardiology, Center for Interventional Vascular Therapy, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
Search for more papers by this authorMasaki Kodaira MD
Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
Search for more papers by this authorYohei Numasawa MD, PhD
Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
Search for more papers by this authorJohn Fox MD
Department of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York
Search for more papers by this authorSripal Bangalore MD, MHA
Division of Cardiology, University School of Medicine, New York, New York
Search for more papers by this authorCorresponding Author
Toshiki Kuno MD, PhD, FESC, FSCAI
Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York
Correspondence
Toshiki Kuno MD, PhD, FESC, FSCAI, Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, First Avenue, 16th street, New York, NY 10003.
Email: [email protected]
Search for more papers by this authorHisato Takagi MD, PhD
Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
Search for more papers by this authorTomo Ando MD
Division of Cardiology, Center for Interventional Vascular Therapy, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
Search for more papers by this authorMasaki Kodaira MD
Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
Search for more papers by this authorYohei Numasawa MD, PhD
Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
Search for more papers by this authorJohn Fox MD
Department of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York
Search for more papers by this authorSripal Bangalore MD, MHA
Division of Cardiology, University School of Medicine, New York, New York
Search for more papers by this authorAbstract
Background
Mechanical circulatory support (MCS) with Impella or intra-aortic balloon pump (IABP) is used for high-risk percutaneous coronary intervention (PCI) and/or for cardiogenic shock (CS) due to acute myocardial infarction. We aimed to investigate the efficacy and safety of Impella or IABP when compared with no MCS using a network meta-analysis of randomized controlled trials (RCTs).
Methods
EMBASE and MEDLINE were searched through February 2020 for RCT evaluating efficacy of Impella vs. IABP vs. no MCS in patients undergoing high-risk PCI or CS. The primary efficacy outcome was 30 day or in-hospital all-cause mortality whereas the primary safety outcomes were major bleeding and vascular complications.
Results
Our search identified nine RCTs enrolling a total of 1,996 patients with high-risk PCI and/or CS. There was no significant difference with Impella or IABP on all-cause mortality when compared with no MCS (Impella vs. no MCS; OR:0.82 [0.35–1.90], p = .65, IABP vs. no MCS; OR:0.77 [0.47–1.28], p = .31, I2 = 18.1%). Impella significantly increased major bleeding compared with no MCS (Impella vs. no MCS; OR:7.01 [1.11–44.4], p = .038, I2 = 19.2%). IABP did not increase the risk of major bleeding compared with no MCS (OR:1.27 [0.75–2.16], p = .38, I2 = 19.2%) but increased vascular complication compared with no MCS (OR:1.92 [1.01–3.64], p = .045, I2 = 1.5%).
Conclusions
Neither Impella nor IABP decreased all-cause short-term mortality when compared with no MCS for high-risk PCI and/or CS. Moreover, Impella increased major bleeding compared with no MCS.
CONFLICT OF INTEREST
Dr Bangalore is on the advisory board for Abbott Vascular, Biotronik, Amgen, and Pfizer. Dr Bangalore has received honoraria from Abbott Vascular, Biotronik, Amgen, and Pfizer.
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