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

Toshiki Kuno, Hisato Takagi, Tomo Ando, Masaki Kodaira, Yohei Numasawa, John Fox, Sripal Bangalore

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)E636-E645
JournalCatheterization and Cardiovascular Interventions
Volume97
Issue number5
DOIs
Publication statusPublished - 2021 Apr 1
Externally publishedYes

Keywords

  • cardiogenic shock
  • Impella
  • intra-aortic balloon pump
  • mechanical circulatory support
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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