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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
Author(s) -
Kuno Toshiki,
Takagi Hisato,
Ando Tomo,
Kodaira Masaki,
Numasawa Yohei,
Fox John,
Bangalore Sripal
Publication year - 2021
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.29236
Subject(s) - impella , medicine , cardiogenic shock , percutaneous coronary intervention , conventional pci , randomized controlled trial , cardiology , intra aortic balloon pump , myocardial infarction , ventricular assist device , surgery , heart failure , intra aortic balloon pumping
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, I 2 = 18.1%). Impella significantly increased major bleeding compared with no MCS (Impella vs. no MCS; OR:7.01 [1.11–44.4], p = .038, I 2 = 19.2%). IABP did not increase the risk of major bleeding compared with no MCS (OR:1.27 [0.75–2.16], p = .38, I 2 = 19.2%) but increased vascular complication compared with no MCS (OR:1.92 [1.01–3.64], p = .045, I 2 = 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.