A Systematic Review and Meta-Analysis of the Efficacy and Safety of Combined Mechanical Circulatory Support in Acute Myocardial Infraction Related Cardiogenic Shock

被引：0

作者：

Soh, Bing Wei Thaddeus ^{[1
]}

Gracias, Carlos Sebastian ^{[2
]}

Dean, Afshan ^{[3
]}

Kumar, Jathinder ^{[1
]}

Asgedom, Solomon ^{[1
]}

Matiullah, Sajjad ^{[1
]}

Owens, Patrick ^{[1
]}

机构：

[1] Univ Hosp Waterford, Dept Cardiol, Waterford, Ireland

[2] Univ Hosp Limerick, Dept Cardiol, Limerick, Ireland

[3] Univ Edinburgh, Usher Inst, Coll Med & Vet Med, Edinburgh, Scotland

来源：

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS | 2025年 / 105卷 / 03期

关键词：

acute myocardial infarction; cardiogenic shock; impella; intra-aortic balloon pump; microaxial flow pump; veno-arterial extracorporeal membrane oxygenation; VENTRICULAR ASSIST DEVICE; INTRAAORTIC BALLOON PUMP; AXIAL-FLOW; INFARCTION; OUTCOMES;

D O I：

10.1002/ccd.31369

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: Acute myocardial infarction-related cardiogenic shock (AMICS) is a severe complication associated with exceedingly high mortality rates. While mechanical circulatory support (MCS) has emerged as a potential intervention, the evidence base for independent MCS use remains weak. In contrast, systematic reviews of observational studies have revealed significant mortality reduction when a combination of MCS was used: VA-ECMO in conjunction with a left ventricular (LV) unloading device (Impella or IABP). The ongoing dilemma concerning the selection between two LV unloading devices (VA-ECMO + Impella vs. VA-ECMO + IABP) warrants further investigation and clarification. Aim: This is the first systematic review and meta-analysis assessing the short-term efficacy and safety of VA-ECMO + Impella versus VA-ECMO + IABP in treatment of AMICS. Methods: A systematic search was performed on the EMBASE, MEDLINE, and Cochrane databases. Studies reporting the short-term (30-day/inpatient) mortality and complications of adult patients with AMICS treated with VA-ECMO + Impella and VA-ECMO + IABP were included. Subgroup analysis was performed including studies with ACS predominant CS (CS etiology 100% by AMI). Results: Four observational studies with 14,247 patients were included. There was no significant difference in mortality between VA-ECMO + Impella and VA-ECMO + IABP (56.5% vs. 66.5%; OR, 0.90; 95% CI, 0.79-1.02; p = 0.09). However, VA-ECMO + Impella was associated with significantly lower mortality in patients with ACS predominant CS (53.2% vs. 67.7%; OR, 0.72; 95% CI, 0.62-0.85; p < 0.0001). VA-ECMO + Impella was concomitantly associated with a significantly higher risk of complications. Conclusions: When comparing LV unloading devices in patients with AMICS requiring a combination of MCS, VA-ECMO + Impella was superior in mortality reduction only in the cohort where 100% of CS was caused by AMI.

引用

页码：650 / 661

页数：12

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